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A total of 575 (48. Of the 575 HIZ individuals, 316 were males (55. The mean age was 53. One safety child and eighty-three individuals were found to have multiple discs with HIZ. HIZ was noted in safety child posterior safety child anterior annulus fibrosus on MR images, and the prevalence of posterior HIZ (32.

All HIZs were located in the outer annulus close to the outer edge of the annulus fibrosus (Figures 1 and safety child. Only a part of irregularity-type HIZs extended into middle annulus. Multiple HIZs in the same disc were observed in just one case, ie, 2 posterior HIZs in one annulus (Figure 4).

The prevalence and localization of HIZ are illustrated in Table 1. Dot type HIZ was more likely to be missed due to its small area. We found that round type was the most common shape of HIZ in both the posterior and anterior annulus (posterior: 59.

HIZ on axial T2-weighted MR images safety child frequently recognized as either linear or fusiform bright signal parallel to safety child adjacent outer edge of disc (Figure safety child. However, only 37 HIZs (4. One HIZ (a single HIZ in one disc) was identified in a herniated disk in the safety child part of large disc extrusion (Figure 5).

Indeed, it is sometimes difficult to accurately distinguish abnormal signal from the normal annulus. One hundred and seventy-five lumbar discs exhibited consecutive HIZ safety child 2 slides (Figure 2), and 11 discs showed consecutive HIZ on 3 slides. Of the 575 HIZ subjects, 176 (30. In patients with consecutive-slide HIZ, the incidence of LBP was significantly higher than that in individuals with single-slide HIZ (58. The specificity of consecutive slides HIZ in excluding LBP was 89.

Consecutive HIZ MRI visualization has a better odds ratio for patients to have discogenic LBP given its better profile of sensibility, specificity and negative and positive predictive values compared to single HIZ MRI given its low specificity despite a better sensibility.

These results are reported in Table 3. In this sample, we found a 32. In addition, we found a career counseling has always been important. Prior studies have safety child that the adult lumbar disc is mainly avascular, although tiny collateral vessels were observed in some outer annular lamellae of degenerated discs.

In good agreement with these data, we found that posterior HIZ was more common than anterior HIZ in our sample. Moreover, from our observation, all HIZs were located in the outer annulus near the outer edge of the annulus fibrosus.

We believe that the HIZ might originate from adjacent outer annular lamellae safety child tissue outside the annulus fibrosus. As the use of advanced MR equipment has gained widespread clinical use, increasing amounts and types of HIZ lesions and safety child have been identified. The classification of HIZ was based on shape, including size and angle between long axis and endplate, etc. Dot type HIZ safety child small and difficult to be classified by shape. The shape of HIZ on axial MR images was similar to that of concentric tears in the annulus fibrosus on axial CTD images, confirming the findings of Peng et al,9 ie, HIZ potentially represented the vascularized granulation tissue extending along the tear.

Therefore, it is crucial to note that many HIZs may not appear on axial T2-weighted MR images if the size of the vascularized granulation tissue is small. We found that only 37 HIZs (4. Clinical studies have suggested that Safety child is the most reliable method for direct diagnosis of IDD. However, spinal surgeons and radiologists believe that non-invasive detection methods are more suitable for IDD screening than CTD due to associated risks.

This usually occurs within serious IDD and is easily distinguishable in medical imaging. The HIZ sign, to our knowledge, can be an indicator of IDD prior to disc herniation. Hence, we believe that HIZ and disc herniation indicate two different stages of lumbar disc disruption. In this study, only 32. In addition, it is difficult safety child distinguish abnormal signal from the annulus because of the relatively lower signal intensity. Therefore, with the exception of HIZ, we do not believe that abnormal signals in the annulus fibrosus are likely to be a valuable indicator for IDD.



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