Lumbar high-intensity zones on MRI: imaging biomarkers for severe, prolonged low back pain and sciatica in a population-based cohort

Abstract

Background Context: There is often discrepancy between clinical presentation and lumbar magnetic resonance imaging (MRI) findings.

Purpose: The purpose of this study was to assess the relationship of high-intensity zones (HIZs) on MRI with low back pain (LBP), sciatica, and back-related disability.

Study design: Cross-sectional, population-based Southern Chinese cohort study.

Patient sample: Of 1,414 possible participants, data from 1214 participants (453 males, 761 females; mean age of 48.1±6.3 years) were included.

Outcome Measures: Presence of single-level, homogeneous multi-level (same type HIZs of morphology and topography) and heterogeneous multi-level (mixed type HIZs of morphology and topography) HIZs and other MRI phenotypes were assessed at each level with T2-weighted 3T sagittal MRI of L1-S1. Associations with LBP, sciatica and Oswestry Disability Index were correlated with HIZ profiles.

Results: In all, 718 individuals had HIZs (59.1%). Disc degeneration/displacement were more prevalent in HIZ individuals (p<0.001). HIZ subjects experienced prolonged severe LBP more frequently (39.6% vs 32.5%; p<0.05) and had higher ODI scores (10.7 ± 13.7 vs 8.9 ± 11.3; p<0.05). Posterior multilevel HIZ were significantly associated with prolonged severe LBP (OR:2.18; 95% CI:1.42-3.37) in comparison to anterior only, anterior/posterior or other patterns of HIZ. Multilevel homogeneous or heterogeneous HIZs were significantly associated with prolonged, severe LBP (OR:1.53 to 1.57; p<0.05). Individuals with homogeneous HIZs had a higher risk of sciatica (OR:1.51, p<0.05).

Conclusions: This is the first large-scale study to note that lumbar HIZs, and specific patterns therein, are potentially clinically-relevant imaging biomarkers that are independently and significantly associated with prolonged/severe LBP and sciatica. HIZs, especially homogenous multilevel HIZ, should be noted in the global pain imaging phenotype assessment.