Percutaneous discography: comparison of low-dose CT, fluoroscopy and MRI in the diagnosis of lumbar disc disruption.

Abstract

To compare the diagnostic accuracy of low-dose computed tomography (CT), magnetic resonance imaging (MRI) and fluoroscopy in percutaneous discography in patients scheduled for lumbar spondylodesis. Within a prospective pilot study, 18 disc segments of 11 patients with radicular or pseudoradicular pain prior to anteroposterior spondylodesis were evaluated. After injection of a mixture of non-ionic iodine-containing contrast agent and gadolinium-based contrast medium into the disc spaces, all patients underwent conventional fluoroscopy, as well as low-dose CT and MRI. The occurrence of memory pain during contrast injection was recorded. CT, MRI and fluoroscopic images were analyzed independently by two readers blinded to the clinical findings. There was 100% agreement between CT and MRI discography in the detection, localization and grading of degenerative changes. In contrast, conventional fluoroscopy identified only 9 of the 12 abnormal segments. Memory pain following puncture was identified in 3 of the 12 affected segments. Low-dose CT and MRI discography have a similar accuracy in the assessment of disc disruption and they are superior to fluoroscopic discography.