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European Radiology

Erschienen in:

03.06.2016 | Musculoskeletal

Does the high-intensity zone (HIZ) of lumbar Intervertebral discs always represent an annular fissure?

verfasst von: Zhi Shan, Huanhuan Chen, Junhui Liu, Hong Ren, Xuyang Zhang, Fengdong Zhao

Erschienen in: European Radiology | Ausgabe 3/2017

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Abstract

Objectives

The aim of this study was to examine high-intensity zone (HIZ) characteristics on both T1- and T2-weighted sagittal magnetic resonance (MR) images, and to reveal their exact nature.

Materials

Seventy-three patients with low back pain and HIZs (identified on T2-weighted images) were included. Patients, aged 25-80 years (mean 51), were divided into two groups: the ‘single-HIZ’ group exhibited HIZs only on T2-weighted images, while the ‘dual-HIZ’ group exhibited HIZs on both T2-weighted and T1-weighted images. Tissue corresponding to the HIZ was harvested from surgery for analysis.

Results

Eighty-two discs were studied, from 39 patients with single HIZs, 30 with dual HIZs, and four with both in the posterior annulus. HIZ volume, volume ratio, and signal intensity on T2-weighted images from the dual-HIZ group were significantly greater. Surgery was able to successfully restore patients’ ability in both groups, while conservative treatments were less effective for patients with dual HIZs. Histology revealed outer annular fissures invaded by granulation tissue in the single-HIZ group. In dual-HIZ discs, Von Kossa staining and CT scans showed more calcified or ossified lesions (94.1 vs. 0 %, P<0.001), and chemical analysis showed significantly higher calcium content.

Conclusions

HIZs on both T2- and T1-weighted images represent calcified tissue, possibly from a vertebral endplate. A new concept of dual HIZ should be defined.

Key Points

• Conventional definition of an HIZ refers to T2-weighted images only.

• Dual HIZs have greater HIZ volume, volume ratio, and signal intensity.

• HIZs on both T2- and T1-weighted images represent calcified tissue.

• Conservative treatments are less likely to be effective for patients with dual HIZs.

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Titel: Does the high-intensity zone (HIZ) of lumbar Intervertebral discs always represent an annular fissure?
verfasst von: Zhi Shan
Huanhuan Chen
Junhui Liu
Hong Ren
Xuyang Zhang
Fengdong Zhao
Publikationsdatum: 03.06.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 3/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4408-1

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Does the high-intensity zone (HIZ) of lumbar Intervertebral discs always represent an annular fissure?

Abstract

Objectives

Materials

Results

Conclusions

Key Points

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