The correlation between the high-intensity zone on a T2-weighted MRI and positive outcomes of discography: a meta-analysis

Background: This meta-analysis aimed to assess the correlation between the high-intensity zone (HIZ) of a lumbar MRI and discography. Methods: We conducted an electronic search of the PubMed, MEDLINE, Embase, and ScienceDirect databases from their respective inceptions to October 2016 using the following search terms: "low back pain," "discogenic low back pain," " HIZ or high-intensity zone," and "discography". Relevant journals and conference proceedings were manually searched. Two reviewers independently assessed the quality of the studies, extracted data from the included studies, and analyzed the data. Results: Eleven studies were included. The results of the meta-analysis indicated that outstanding relativity and statistically significant correlations were observed between the HIZ and abnormal disc morphology (OR = 47.79; 95% CI: 17.07 to 133.77; P < 0.00001), HIZ and pain reproduction (OR = 8.65, 95% CI: 6.01 to 15.23, P < 0.00001), and HIZ and abnormal morphology pain reproduction (OR = 11.74, 95% CI: 1.99 to 69.36, P = 0.007). Conclusions: The presence of an HIZ on a lumbar MRI T2-weighted image indicates abnormal disc morphology. There is a strong relationship between the HIZ and pain reproduction. The HIZ can be an effective index for prediction of discogenic low back pain.