Picture archiving and communication systems (PACS) are aimed to improve reporting efficiency, and their introduction has resulted in an increase of the number of both reported IF and follow-up examinations. At lumbar spine magnetic resonance imaging (MRI), despite the signal saturation bands that are used in standard international protocols to reduce the number and severity of artefacts, incidental abnormalities may arise from a wide range of abdominal and pelvic organs and the diseases encountered may be extremely diverse. The detection of such findings poses various practical and ethical issues concerning clinical management. Lumbar spine MRI may reveal either clinically insignificant spine incidental abnormalities and/or extra-spinal IF that, at times, may even explain the patientвЂ™s symptoms. Incidental findings (IF) at imaging are defined as previously undetected abnormalities that are unexpectedly discovered and are unrelated to the purpose of the examination. Our study shows that incidental extra-spinal findings at conventional lumbar spine MRI are common but underestimated in radiological reports.

After review of the original archived radiological reports, potentially important C-RADS E3 and E4 extra-spinal IF were respectively reported in 47 of the 265 (17.7В %) and in 8 of 74 (10.8В %) patients. ResultsД«y means of the structured approach used, extra-spinal findings were detected in 2,060 (68.6В %) of the 3,000 lumbar spine MRI examinations 362 (17.6В %) patients had indeterminate or clinically important findings (E3 and E4) requiring clinical correlation or further evaluation. We retrospectively compared our structured approach with the archived MRI reports as it regarded the detection of extra-spinal IF to estimate non-detection rates. Extra-spinal abnormalities were classified according to a modified CT Colonography Reporting and Data System (C-RADS). By means of randomisation, we retrospectively reviewed 3,000 lumbar spine MRI examinations. MethodsДЄ retrospective search of patients undergoing lumbar spine MRI from January 2006 to December 2010 was conducted. Corenman said that low Tesla strength MRI magnets generally confer a poor interpretation, and that diagnoses may be missed using MRIs of less than 1T.To determine the prevalence of clinically and non-clinically relevant extra-spinal incidental findings (IF) in patients undergoing magnetic resonance imaging (MRI) of the lumbar spine and to evaluate the rate of undetected findings in archived radiological reports. That is why the clinical and data science teams at Spreemo Health and I are working to develop a nationally recognized benchmark for diagnostic quality that factors in both subspecialization as well other quality measures,вЂќ Dr. вЂњOverall, our study has demonstrated that where (and how) a patient obtains his or her MRI exam may have a direct and meaningful impact on his or her diagnosis, subsequent treatment pathway, and ultimate clinical outcome. вЂњA radiologist who interprets a large number of spinal MRI exams may be an expert in spinal diagnosis, even if he or she has not received fellowship training.вЂќ вЂњNonetheless, if there is, in fact, no imaging center in your area with a fellowship-trained radiologist, you can direct your patient to a center that performs the largest number of spine exams,вЂќ Dr. All centers were accredited by the American College of Radiology and were unaware that the patient was part of this study. The equipment used at these study centers included open 0.3T (1 center), stand-up 0.6T (1 center), closed 1.5T (7 centers), and closed 3.0T (1 center) MRI systems. The patient underwent 10 MRI examinations of the lumbar spine at 10 different regional imaging centers in the New York City area over a 3-week period. The study patient was a 63-year-old woman with a history of low back pain and right L5 radiculopathy. Unfortunately, other than spine surgeons and neurosurgeons, other providers more likely are dependent upon the radiologist to read the MRI and interpret the findings, Dr. Corenman, MD, DC, Orthopaedic Spine Surgeon at The Steadman Clinic in Vail, CO. вЂњThe findings demonstrate why spine surgeons should never trust a reading from a radiologist without viewing the MRI themselves,вЂќ commented Donald S. Herzog, MD, FACR, Director of Spinal Imaging at Hospital for Special Surgery and Executive Director of Spreemo HealthвЂ™s Quality Research Institute (QRI) in New York City. вЂњI have worked in the area of spinal imaging for 25 years, and in my judgment, subspecialization is probably the single most important factor in determining the quality of MRI interpretation,вЂќ said Richard J.

вЂњThe findings demonstrate why spine surgeons should never trust a reading from a radiologist without viewing the MRI themselvesвЂќ.

How to read mri images of lumbar spine