Modic changes on MR images as studied with provocative diskography: clinical relevance--a retrospective study of 2457 disks.
Radiology
; 250(3): 849-55, 2009 Mar.
Article
en En
| MEDLINE
| ID: mdl-19244050
ABSTRACT
PURPOSE:
To assess the value of vertebral body endplate signal intensity (Modic) changes on magnetic resonance (MR) images in predicting a painful disk, with provocative diskography as the reference standard. MATERIALS ANDMETHODS:
Lumbar spine diskograms and prediskogram MR images of 736 patients (2457 disks) were retrospectively reviewed as part of an institutional review board-approved HIPAA-compliant protocol. Each disk was assigned a Modic subtype type 0, normal; type 1, nonfatty high signal intensity; type 2, fatty; and type 3, sclerosis. Statistical analysis involved use of a 2 x 2 contingency table of diskogram results for each of the subtypes. The subtype sensitivity, specificity, positive predictive value (PPV), negative predictive value, and confidence intervals (CIs) were calculated. Similar analyses of other MR variables (such as disk herniation, high signal intensity zone, and spondylolisthesis) and type 1 signal intensity changes also were performed.RESULTS:
Type 1 changes (n = 155) had a high PPV (0.81; 95% CI 0.74, 0.87) for a provocative diskogram. Type 2 changes (n = 126) had a lower PPV (0.64; 95% CI 0.55, 0.72) for a positive diskogram. Type 3 changes (n = 21) had a PPV (0.57; 95% CI 0.34, 0.78) that was not significant for a positive diskogram. The PPV of an endplate with a type 1 change (hereafter, type 1 endplate) for a tear in the annulus fibrosis of the disk was also insignificant (0.14; 95% CI 0.09, 0.20). A similar analysis between a type 1 endplate and the presence of a disk herniation (PPV, 0.26; 95% CI 0.19, 0.34) and between a type 1 endplate and vertebral body spondylolisthesis (PPV, 0.28; 95% CI 0.20, 0.35) were significant.CONCLUSION:
Type 1 signal intensity changes on MR images have a high positive predictive value in the identification of a pain generator.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Imagen por Resonancia Magnética
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Dolor de la Región Lumbar
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Disco Intervertebral
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Desplazamiento del Disco Intervertebral
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
Radiology
Año:
2009
Tipo del documento:
Article
País de afiliación:
Estados Unidos