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Review
. 2012 Feb;21(2):220-7.
doi: 10.1007/s00586-011-2019-8. Epub 2011 Sep 16.

Magnetic Resonance Imaging for Diagnosing Lumbar Spinal Pathology in Adult Patients With Low Back Pain or Sciatica: A Diagnostic Systematic Review

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Free PMC article
Review

Magnetic Resonance Imaging for Diagnosing Lumbar Spinal Pathology in Adult Patients With Low Back Pain or Sciatica: A Diagnostic Systematic Review

Merel Wassenaar et al. Eur Spine J. .
Free PMC article

Abstract

Purpose: In about 5% of all cases LBP is associated with serious underlying pathology requiring diagnostic confirmation and directed treatment. Magnetic resonance imaging (MRI) is often used for this diagnostic purpose yet its role remains controversial. Consequently, this review aimed to summarize the available evidence on the diagnostic accuracy of MRI for identifying lumbar spinal pathology in adult low back pain (LPB) or sciatica patients.

Methods: MEDLINE, EMBASE and CINAHL were searched (until December 2009) for observational studies assessing the diagnostic accuracy of MRI compared to a reference test for the identification of lumbar spinal pathology. Two reviewers independently selected studies for inclusion, extracted data and assessed methodological quality. Pooled summary estimates of sensitivity and specificity with 95% confidence intervals were calculated for homogenous subsets of studies.

Results: Eight studies were included in this review. Strata were defined for separate pathologies i.e. lumbar disc herniation (HNP) and spinal stenosis. Five studies comparing MRI to findings at the surgery for identifying HNP were included in a meta-analysis. Pooled analysis resulted in a summary estimate of sensitivity of 75% (95% CI 65-83%) and specificity of 77% (95% CI 61-88%). For spinal stenosis pooling was not possible.

Conclusions: The results suggest that a considerable proportion of patients may be classified incorrectly by MRI for HNP and spinal stenosis. However, the evidence for the diagnostic accuracy of MRI found by this review is not conclusive, since the results could be distorted due to the limited number of studies and large heterogeneity.

Figures

Fig. 1
Fig. 1
Flow chart of literature search process
Fig. 2
Fig. 2
Results of the assessment of methodological quality items presented as percentage across all included studies
Fig. 3
Fig. 3
Methodological quality for each included study
Fig. 4
Fig. 4
Forest plot of study results per pathology group describing sensitivities and specificities with accompanying 95% confidence intervals as well as the numbers of TP true positive, FP false positive, FN false negative and TN true negative results
Fig. 5
Fig. 5
Summary ROC plot presenting pooled estimates of sensitivity and specificity including 95% confidence ellipse and hierarchical ROC curve summary based on bivariate analysis of five studies describing the diagnostic accuracy of MRI for identifying lumbar disc herniation

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