High Intensity Zone Identified on MRI
High Intensity Zone Identified on MRI
MRI is the imaging of choice to identify the integrity of the intervertebral disc and its relation to adjacent neurologic structures in patients with neurologic findings or persistent pain. Positive MRI findings of disc herniation with nerve root compression can be easily correlated with radicular findings. However, correlating local low back pain can be challenging in the absence of disc herniation.
This paper looked at identifying hi-signal-intensity zones (HIZ) on MRI. "...hi-signal-intensity zones (HIZ) at first described Aprill and Bogduk in 1992. HIZ are defined as small foci of high signal intensity at: mid-sagittal T2-weighted images, or contrast enhancement T1-weighted images" (Gallucci, Anselmi, Di Sibio, & Gregori, 2011, p. S161). "HIZ are considered to represent a severe form of combined radial and concentric annular tear" (Gallucci et al., 2011, p. S162).
The authors of this article state, “Many studies have shown a strong association between imaging evidence of an annular tear and the presence of elicited pain during discography at the same disk…..in symptomatic patients, the location of these tears has been shown to correlate with the level of painful disk noted at diskography" (Gallucci et al., 2011, p. S163). When treating the traumatically injured, the intervertebral disc can be a source of pain. If a tear in the disc material is the cause of the pain, it is crucial to be able to identify that tear on MRI in order to correlate the patient’s symptoms.
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Reference:
Gallucci, M., Anselmi, M., Di Sibio, A., & Gregori, L. M. (2011). Annular tear, fissures or HIZ? Neuroradiology,53(Suppl 1),S161-S165.