摘要目的 研究腰椎间盘MRI高信号区(HIZ)与椎间盘造影诱发疼痛反应之间的关系,为椎间盘源性下腰痛诊断和治疗提供参考.方法 对37例长期慢性下腰痛、无典型的神经根性症状和体征,且CT证实无椎间盘突出的患者行MRI检查和腰椎间盘造影.分析造影后的X线片和CT片,并结合造影时诱发的疼痛反应,比较其与腰椎间盘MRI高信号区之间的关系.结果 37例患者共行98个腰椎间盘造影,21个椎间盘疼痛反应阳性,其中有HIZ的间盘10个,占47.6%.77个疼痛反应阴性的椎间盘中,有HIZ的间盘29个,占37.6%.纤维环破裂程度分级越高,MRI出现高信号区的比例也越高,说明有高信号区的纤维环破裂程度高,无高信号区的纤维环破裂程度低(P＜0.01);而高信号区与造影疼痛反应阳性之间并无明显一致性(P＞0.05).结论 MRI高信号区在诊断椎间盘源性腰痛中仅为提示性和筛选性的影像学征象,不能替代椎间盘造影的金标准.

abstractsObjective To study correlation between high intensity zone(HIZ)of lumbar disc and positive pain response on lumbar discography for the diagnosis and treatment of discogenic low back pain.Methods Thirty-seven cases with chronic low back pain without neurologic symptoms and lumbar disc herniation on CT scan underwent lumbar discography and MRI examination.X-ray and CT after discography with positive pain response were analyzed to correlate with HIZ on MRI.Results Ninety-eight discs underwent discography in 37 patients.Twenty-one discs presented positive pain response;including 10 have HIZ(47.6%).Seventy-seven discs presented negative pain response;including 29 had HIZ(37.6%).The higher grade of annular disruption group had the higher proportion of HIZ on lumbar MRI.There was a positive correlation between HIZ and degree of annular disruption.However,there was no correlation between HIZ and positive pain response on lumbar discography.Conclusions HIZ on lumbar MRI only can be a filtrated and suggestive image sign and can not replace discography in the diagnosis and treatment of discogenic low back pain.