Patient symptom information enhances MRI accuracy for lumbar spine diagnosis

Knowing a patient's symptoms helps radiologists in lumbar spine MRI interpretation and diagnosis, according to a study published today in Radiology, a journal of the Radiological Society of North America (RSNA).

MRI is the most important imaging exam in patients with back pain or sciatica because it shows nearly all degenerative and structural abnormalities of the spine.

However, MRI often shows spinal abnormalities in individuals who do not have symptoms. Because the same abnormalities can occur in both symptomatic and asymptomatic individuals, it is impossible to distinguish an incidental MRI finding from the true cause of pain by only looking at the MRI.

To diagnose the true cause of pain, it is critical to match the MRI abnormalities with patients' symptoms. Since radiologists may not have access to detailed, high-quality symptom information at the time of MRI interpretation, their reports usually list all the spinal abnormalities without specifying the one most likely causing symptoms.

MRI exams of the lumbar spine often show many degenerative abnormalities. Most of these are incidental findings that do not cause pain. To diagnose the true pain generators and make the best treatment decisions, symptoms must be matched with MRI abnormalities."

William E. Palmer, M.D., study author, division chief of Musculoskeletal Radiology at Massachusetts General Hospital (Mass General) in Boston

Patients at Mass General complete a short symptom questionnaire prior to their lumbar spine MRI. They answer questions about the severity of their pain, where it is located, what makes it worse, and what makes it better.

"The questionnaire is important because it obtains symptom information directly from patients and communicates it to radiologists at the time of lumbar spine MRI interpretation," Dr. Palmer said.

Dr. Palmer and colleagues sought to determine exactly how beneficial patient-reported symptom information is at the time of MRI interpretation.

For this prospective, multi-reader study, the investigators included a total of 240 Mass General patients who completed a symptom questionnaire prior to their lumbar spine MRI.

Musculoskeletal radiologists ranging from 2 to 24 years of experience alternated the reading of MRIs with or without symptom information from the questionnaire. Their diagnoses were then compared to the diagnoses of spine specialists, who conducted face-to-face interviews with patients to make their assessments and decide on treatments.

Radiologists who had access to questionnaire information during MRI interpretation achieved a near statistically perfect agreement with spine specialists.

MRI interpretations without patient-reported symptom information resulted in a significant decrease in diagnostic accuracy and confidence. The questionnaire helped to avoid diagnostic discrepancies between radiologists and spine specialists.

"By distinguishing actionable pain generators from incidental findings, radiologists can best help primary care physicians who depend on MRI reports to guide their treatments and referrals," Dr. Palmer said.

"Impact of Patient-reported Symptom Information on the Interpretation of MRI of the Lumbar Spine." Collaborating with Dr. Palmer were Rene Balza, M.D., Sarah F. Mercaldo, Ph.D., Ambrose J. Huang, M.D., Jad S. Husseini, M.D., Mohamed Jarraya, M.D., F. Joseph Simeone, M.D., and Joao R. T. Vicentini, M.D.