Mark J Hancock1, Chris G Maher2, Jeffrey G Jarvik3, Michele C Battié4, James M Elliott5,6,7, Tue S Jensen8,9,10, John Panagopoulos11, Hazel Jenkins1, Margery C Pardey1, Jeffery McIntosh12, John Magnussen13. 1. Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia. 2. Sydney School of Public Health, The University of Sydney, Director Institute for Musculoskeletal Health, Sydney, New South Wales, Australia. 3. Department of Radiology and Neurological Surgery, Adjunct Professor of Health Services, Pharmacy and Orthopedics & Sports Medicine, University of Washington, Seattle, Washington, USA. 4. Professor and Western Research Chair, Faculty of Health Sciences and Western's Bone and Joint Institute, Western University, London, Ontario, Canada. 5. Faculty of Medicine and Health, The University of Sydney, The Kolling Institute, Sydney, New South Wales, Australia. 6. Northern Sydney Local Health District, Sydney, New South Wales, Australia. 7. Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. 8. Chiropractic Knowledge Hub, Odense, Denmark. 9. Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark. 10. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 11. Active Physiotherapy Newtown, Newtown, New South Wales, Australia. 12. Macquarie Medical Imaging and Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia. 13. Department of Clinical Medicine, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: The importance of lumbar findings on magnetic resonance imaging (MRI) remains controversial. Changes in lumbar MRI findings over time may provide important insights into the causes of low back pain. However, the reliability and validity of temporal changes are unknown. OBJECTIVE: To (1) investigate the interrater reliability of subjective radiologist reporting of temporal changes in lumbar spine MRI findings and (2) determine how commonly temporal changes are reported when two scans are conducted 30 minutes apart (considered false positives). DESIGN: Cross-sectional study. SETTING: Radiology clinic. PARTICIPANTS: Forty volunteers (mean age 40; 53% female) with current (n = 31) or previous (n = 9) low back pain underwent initial lumbar MRI on a single 3T scanner. Participants then lay on a bed for 30 minutes before undergoing an identical MRI. In addition, we purposely selected five participants from a previous study with repeat lumbar MRI scans where temporal changes were reported in at least one MRI finding (1-12 weeks after initial scan) and another five participants where no temporal change was reported. The 10 participants were included in analyses for aim 1 only. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two blinded radiologists reported on temporal changes between the baseline and repeat scan for 12 different MRI findings (eg, disk herniation, annular fissure) at five levels. RESULTS: The interrater reliability of subjective reporting of temporal changes was poor for all MRI findings based on Kappa values (≤ 0.24), but agreement was relatively high (≥ 90.8%). This is explained by the low prevalence of temporal changes as demonstrated by high values for Prevalence and Bias Adjusted Kappa (≥ 0.82). "False positive" temporal changes were reported by at least one radiologist for most MRI findings, but the rate was generally low. CONCLUSIONS: Caution is required when interpreting temporal changes in lumbar MRI findings owing to low reliability and some false positive reporting.
BACKGROUND: The importance of lumbar findings on magnetic resonance imaging (MRI) remains controversial. Changes in lumbar MRI findings over time may provide important insights into the causes of low back pain. However, the reliability and validity of temporal changes are unknown. OBJECTIVE: To (1) investigate the interrater reliability of subjective radiologist reporting of temporal changes in lumbar spine MRI findings and (2) determine how commonly temporal changes are reported when two scans are conducted 30 minutes apart (considered false positives). DESIGN: Cross-sectional study. SETTING: Radiology clinic. PARTICIPANTS: Forty volunteers (mean age 40; 53% female) with current (n = 31) or previous (n = 9) low back pain underwent initial lumbar MRI on a single 3T scanner. Participants then lay on a bed for 30 minutes before undergoing an identical MRI. In addition, we purposely selected five participants from a previous study with repeat lumbar MRI scans where temporal changes were reported in at least one MRI finding (1-12 weeks after initial scan) and another five participants where no temporal change was reported. The 10 participants were included in analyses for aim 1 only. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two blinded radiologists reported on temporal changes between the baseline and repeat scan for 12 different MRI findings (eg, disk herniation, annular fissure) at five levels. RESULTS: The interrater reliability of subjective reporting of temporal changes was poor for all MRI findings based on Kappa values (≤ 0.24), but agreement was relatively high (≥ 90.8%). This is explained by the low prevalence of temporal changes as demonstrated by high values for Prevalence and Bias Adjusted Kappa (≥ 0.82). "False positive" temporal changes were reported by at least one radiologist for most MRI findings, but the rate was generally low. CONCLUSIONS: Caution is required when interpreting temporal changes in lumbar MRI findings owing to low reliability and some false positive reporting.
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