Second-Opinion Subspecialty Consultations in Musculoskeletal Radiology

AJR Am J Roentgenol. 2016 Jun;206(6):1217-21. doi: 10.2214/AJR.15.14540. Epub 2016 Apr 8.


Objective: The purpose of this article is to evaluate the significance of subspecialty second-opinion consultations for CT and MRI examinations in musculoskeletal (MSK) radiology.

Materials and methods: All 3165 MSK CT and MRI examinations referred to one academic institution for second-opinion consultation during a 24-month period were reviewed by three MSK-trained radiologists. Outside and inside reports were compared by two independent MSK radiology fellows using a previously published 5-point scale. Clinically important differences (categories 4 and 5) were defined as those likely to change patient management. Statistical comparisons of rates were performed using a chi-square test with Bonferroni corrections. Interobserver reliability was reported using linear weighted kappa statistics and the percentage of agreement.

Results: Of all second-opinion examinations, 73.5% (2326/3165) had an outside report available for comparison and inclusion in this study. There were 610 of 2326 (26.2%) examinations with clinically important differences. The rate of clinically important discrepant readings was even higher in oncologic cases (36.3%; 331/911). When the final diagnosis was determined from pathology reports performed after internal interpretation, the second-opinion consultation was noted to be correct in 82.0% (334/407) of examinations with category 4 or 5 discrepancies. There was very good agreement (κ = 0.93) in scoring the discrepancies between second-opinion consultants.

Conclusion: The subspecialty second-opinion consultation was more accurate than outside reports in 82.0% of examinations when pathologic confirmation was made. A moderate rate (26.2%) of discrepant interpretations was noted between outside and inside MSK imaging examinations, especially in tumor cases (36.3%). Most discrepancies were in interpreting rather than detecting abnormalities.

Keywords: consultation; discrepancy; imaging; musculoskeletal; second opinion.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / diagnostic imaging*
  • Radiology*
  • Referral and Consultation*
  • Reproducibility of Results
  • Retrospective Studies
  • Specialization*
  • Tomography, X-Ray Computed*
  • Young Adult