Performance of On-Call Radiology Residents in Interpreting Total Spine MRI Studies for the Detection of Spinal Cord Compression or Cauda Equina Compression

AJR Am J Roentgenol. 2019 Dec;213(6):1341-1347. doi: 10.2214/AJR.19.21505. Epub 2019 Sep 25.


OBJECTIVE. Accurate diagnosis of spinal cord compression (SCC) or cauda equina compression (CEC) is important in the emergency setting so management decisions may be made promptly. The purpose of this study is to evaluate the performance of on-call radiology residents in interpreting total spine MRI studies for the detection of SCC or CEC. MATERIALS AND METHODS. On-call radiology residents' preliminary interpretation of total spine MRI studies performed over a period of two and half years were evaluated. Agreements and disagreements were determined for SCC (defined as severe spinal stenosis with compression of the spinal cord and lack of surrounding CSF), CEC (defined as > 75% narrowing of the lumbar canal and lack of CSF in the thecal sac), and the presence of other significant findings that might impact clinical management. Studies with true-positive, true-negative, false-positive, and false-negative findings were identified. RESULTS. SCC or CEC was present in 72 of the 295 studies with preliminary interpretations done by on-call residents. The sensitivity and specificity for detecting SCC or CEC were 93.1% and 98.2%, respectively. Sensitivity was higher for 3rd- and 4th-year residents (97.7%) than for 2nd-year residents (86.2%). Other significant findings were present in 34 of the 295 studies. The overall sensitivity and specificity for the detection of other significant findings were 85.3% and 100.0%, respectively. The level of training did not affect the detection of other significant findings. CONCLUSION. The overall sensitivity of on-call radiology residents' interpretation of total spine MR images for the detection of SCC or CEC was high, improving with their level of training. However, residents' sensitivity was slightly less for the detection of other significant findings. Resident performance can be further improved with focused training and the use of a preliminary interpretation template.

Keywords: MRI; internship; radiology education; residency; spine.

MeSH terms

  • Aged
  • Cauda Equina / diagnostic imaging*
  • Clinical Competence*
  • Contrast Media
  • Female
  • Humans
  • Internship and Residency*
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Radiology / education
  • Retrospective Studies
  • Sensitivity and Specificity
  • Spinal Cord Compression / diagnostic imaging*


  • Contrast Media