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Peripheral annular fissures (annular high intensity zones [HIZ]) identified on T2 weighted MR imaging are known to correlate with diskogenic low back pain as demonstrated at provocation lumbar diskography. Buy Femara without prescription, (1) Studies have also demonstrated that enhancement may be common in peripheral annular fissures and T2 conspicuity may decrease with time. (2) The purpose of this study was to correlate the provocation diskogram response and diskogram imaging appearance of lumbar disks with peripheral annular fissures as demonstrated on pre-procedure combined unenhanced and enhanced MR imaging.

Methods & Materials

Over the course of 5 years, where can i find Femara online, Order Femara online c.o.d, 43 patients were identified who had combined unenhanced and enhanced lumbar MR imaging available as their pre-procedure study prior to provocation lumbar diskography. Peripheral posterior annular fissure was identified as focal enhancement of the annulus on post-contrast imaging at 28 un-operated disk levels in 19 of these patients (10 female, purchase Femara online, Online buy Femara without a prescription, 9 male; age range 19-62 years, average 41 years) and form the focus of this study, buy cheap Femara. Order Femara no prescription, Signal abnormality of the posterior annulus was graded on the sagittal T2 weighted MR sequence utilizing a 4 point scale by consensus of three experienced neuroradiologists: grade 1: negative/barely visible; grade 2: slight posterior annular signal; grade 3: obvious bright posterior annular signal; grade 4: posterior annular signal comparable to CSF. Grade 1-2 was considered no annular fissure, grade 3-4 was considered likely or definite annular fissure, buy Femara without prescription.

Features identified at diskography were tabulated for each disk with annular fissure including: pain response (concordant, order Femara online overnight delivery no prescription, Online buying Femara hcl, discordant, negative), Femara trusted pharmacy, Order Femara from mexican pharmacy, anesthetic response, diskogram and post-diskogram imaging appearance (radial defect/tear, buy Femara without a prescription, Buy Femara online cod, degenerative change, diskographic contrast leakage).


Pain was provoked at diskography in 24 of 28 (85.7%) disk levels with an annular fissure identified on post-contrast MR imaging (concordant: 18 (64.3%), buy Femara no prescription, Buy cheap Femara no rx, discordant: 6 (21.4%)) with 4 disk levels normal. Traditional HIZ (annular fissure) was judged to be present on sagittal T2 weighted sequence in only 15 of 28 disks (grade 3-4) and was judged not to be present in 13 of 28 disks (grade 1-2), canada, mexico, india. Purchase Femara online no prescription, Diskographic contrast leakage was identified in 12 disks, with 16 disks being contained, where can i buy Femara online. Buy no prescription Femara online, Provoked pain response to intradiskal lidocaine injection included: total/substantial pain relief: 6 disks (leak: 6); partial improvement: 6 disks (leak: 2, contained: 4); no improvement 10 disks (leak: 2; contained: 8) with no lidocaine injected at 6 levels (normal: 4; volume restriction: 2).


Annular fissure as identified on post-contrast MR imaging shows high correlation with diskogenic low back pain identified at provocation lumbar diskography, Femara price. Buy Femara without prescription, Annular fissures may be missed on sagittal T2 weighted imaging due to lack of sufficient signal intensity. Purchase Femara online, Routine application of post-contrast MR imaging in lumbar spine evaluation may markedly improve prediction of diskogenic low back pain. Discordant pain might represent disks that have undergone partial healing.

References/Financial Disclosures

1, buy Femara from mexico. Australia, uk, us, usa, Schellhas KP, Pollei SR, Femara coupon, Where can i order Femara without prescription, Gundry CR, et al, buy Femara without prescription. Japan, craiglist, ebay, overseas, paypal, Lumbar disc high-intensity zone. Correlation of magnetic resonance imaging and discography, buy Femara without prescription. Spine 1996;21:79-86

2, buy generic Femara. Femara over the counter, Munter FM, Wasserman BA, Femara for sale, Where can i buy cheapest Femara online, Wu HM, et al, Femara from canadian pharmacy. Order Femara online c.o.d, Serial MR Imaging of Annular Tears in Lumbar Intervertebral Disks. AJNR Am J Neuroradiol 2002;23:1105-1109

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