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Classification of High Intensity Zones of the Lumbar Spine and Their Association with Other Spinal MRI Phenotypes: The Wakayama Spine Study

Author

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  • Masatoshi Teraguchi
  • Dino Samartzis
  • Hiroshi Hashizume
  • Hiroshi Yamada
  • Shigeyuki Muraki
  • Hiroyuki Oka
  • Jason Pui Yin Cheung
  • Ryohei Kagotani
  • Hiroki Iwahashi
  • Sakae Tanaka
  • Hiroshi Kawaguchi
  • Kozo Nakamura
  • Toru Akune
  • Kenneth Man-Chee Cheung
  • Noriko Yoshimura
  • Munehito Yoshida

Abstract

Introduction: High intensity zones (HIZ) of the lumbar spine are a phenotype of the intervertebral disc noted on MRI whose clinical relevance has been debated. Traditionally, T2-weighted (T2W) magnetic resonance imaging (MRI) has been utilized to identify HIZ of lumbar discs. However, controversy exists with regards to HIZ morphology, topography, and association with other MRI spinal phenotypes. Moreover, classification of HIZ has not been thoroughly defined in the past and the use of additional imaging parameters (e.g. T1W MRI) to assist in defining this phenotype has not been addressed. Materials and Methods: A cross-sectional study of 814 (69.8% females) subjects with mean age of 63.6 years from a homogenous Japanese population was performed. T2W and T1W sagittal 1.5T MRI was obtained on all subjects to assess HIZ from L1-S1. We created a morphological and topographical HIZ classification based on disc level, shape type (round, fissure, vertical, rim, and enlarged), location within the disc (posterior, anterior), and signal type on T1W MRI (low, high and iso intensity) in comparison to the typical high intensity on T2W MRI. Results: HIZ was noted in 38.0% of subjects. Of these, the prevalence of posterior, anterior, and both posterior/anterior HIZ in the overall lumbar spine were 47.3%, 42.4%, and 10.4%, respectively. Posterior HIZ was most common, occurring at L4/5 (32.5%) and L5/S1 (47.0%), whereas anterior HIZ was most common at L3/4 (41.8%). T1W iso-intensity type of HIZ was most prevalent (71.8%), followed by T1W high-intensity (21.4%) and T1W low-intensity (6.8%). Of all discs, round types were most prevalent (anterior: 3.6%, posterior: 3.7%) followed by vertical type (posterior: 1.6%). At all affected levels, there was a significant association between HIZ and disc degeneration, disc bulge/protrusion and Modic type II (p

Suggested Citation

  • Masatoshi Teraguchi & Dino Samartzis & Hiroshi Hashizume & Hiroshi Yamada & Shigeyuki Muraki & Hiroyuki Oka & Jason Pui Yin Cheung & Ryohei Kagotani & Hiroki Iwahashi & Sakae Tanaka & Hiroshi Kawaguch, 2016. "Classification of High Intensity Zones of the Lumbar Spine and Their Association with Other Spinal MRI Phenotypes: The Wakayama Spine Study," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-15, September.
  • Handle: RePEc:plo:pone00:0160111
    DOI: 10.1371/journal.pone.0160111
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    1. Tony Vangeneugden & Annouschka Laenen & Helena Geys & Didier Renard & Geert Molenberghs, 2005. "Applying Concepts of Generalizability Theory on Clinical Trial Data to Investigate Sources of Variation and Their Impact on Reliability," Biometrics, The International Biometric Society, vol. 61(1), pages 295-304, March.
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