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Magnetic Resonance Imaging Interpretation in Patients With Symptomatic Lumbar Spine Disc Herniations: Comparison of Clinician and Radiologist Readings

Lurie, Jon D. MD, MS*; Doman, David M. MD; Spratt, Kevin F. PhD; Tosteson, Anna N. A. ScD*; Weinstein, James N. DO, MS

doi: 10.1097/BRS.0b013e31819b390e

Study Design. Retrospective review of imaging data from a clinical trial.

Objective. To compare the interpretation of lumbar spine magnetic resonance imaging (MRIs) by clinical spine specialists and radiologists in patients with lumbar disc herniation.

Summary of Background Data. MRI is the imaging modality of choice for evaluation of the lumbar spine in patients with suspected lumbar disc herniation. Guidelines provide standardization of terms to more consistently describe disc herniation. The extent to which these guidelines are being followed in clinical practice is unknown.

Methods. We abstracted data from radiology reports from patients with lumbar intervertebral disc herniation enrolled in the Spine Patient Outcomes Research Trial. We evaluated the frequency with which morphology (e.g., protrusions, extrusions, or sequestrations) was reported as per guidelines and when present we compared the morphology ratings to those of clinicians who completed a structured data form as part of the trial. We assessed agreement using percent agreement and the κ statistic.

Results. There were 396 patients with sufficient data to analyze. Excellent agreement was observed between clinician and radiologist on the presence and level of herniation (93.4%), with 3.3% showing disagreement regarding level, of which a third could be explained by the presence of a transitional vertebra. In 3.3% of the cases in which the clinician reported a herniation (protrusion, extrusion, or sequestration), the radiologist reported no herniation on the MRI.

The radiology reports did not clearly describe morphology in 42.2% of cases. In the 214 cases with clear morphologic descriptions, agreement was fair (κ = 0.24) and the disagreement was asymmetric (Bowker’s test of symmetry P < 0.0001) with clinicians more often rating more abnormal morphologic categories. Agreement on axial location of the herniation was excellent (κ = 0.81). There was disagreement between left or right side in only 3.3% of cases (κ = 0.93).

Conclusion. Radiology reports frequently fail to provide sufficient detail to describe disc herniation morphology. Agreement between MRI readings by clinical spine specialists and radiologists was excellent when comparing herniation vertebral level and location within level, but only fair comparing herniation morphology.

A retrospective review of imaging data from a clinical trial Spine Patient Outcomes Research Trial to compare the interpretation of lumbar spine magnetic resonance imagings by clinical spine specialists and radiologists in patients with lumbar disc herniations.

From the *Department of Medicine, Hanover, NH; †Dartmouth Medical School, Hanover, NH; and ‡Department of Orthopaedics; Hanover, NH.

Acknowledgment date: June 21, 2008. Revision date: October 8, 2008. Acceptance date: October 16, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by The National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01-AR45444-01A1) and the Office of Research on Women’s Health, the National Institutes of Health, and the National Institute of Occupational Safety and Health, the Centers for Disease Control and Prevention; and a Research Career Award from NIAMS (1 K23 AR 048138-01) (to J.D.L.). The Multidisciplinary Clinical Research Center in Musculoskeletal Diseases is funded by National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60-AR048094-01A1).

Address correspondence and reprint requests to Jon D. Lurie, MD, MS, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, HB 7999, Lebanon, NH 03756.

© 2009 Lippincott Williams & Wilkins, Inc.