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Objectives The objective of the review was to examine the evidence comparing upright to supine MRI of the lumbar spine. Key findings A literature search identified 14 articles comparing data where subjects had been scanned in both supine and upright positions on the same scanner. Lumbar spine anatomy is dynamic and therefore subject to morphological changes when transitioning from the supine to the upright position. There is strong evidence to suggest structural changes in spinal morphology due to radiographic positioning, and that upright positioning is better for evaluating spondylolisthesis. Conclusion It has been demonstrated that the scanning position is important in the outcome of the MRI examination of the lumbar spine. With this in mind, it would be beneficial for guidance to be written and adopted to improve the consistency and quality of scanning. Implications for practice As upright MRI occupies a niche in the scanning sector, many professionals are unaware of its capabilities. This article aims to increase awareness of the use of upright MRI in evaluating the lumbar spine.

Conventional measures of radiologist efficiency, such as the relative value unit, fail to account for variations in the complexity and difficulty of a given study. For lumbar spine MRI (LMRI), an ideal performance metric should account for the global severity of lumbar degenerative disease (LSDD) which may influence reporting time (RT), thereby affecting clinical productivity. This study aims to derive a global LSDD metric and estimate its effect on RT. A 10-year archive of LMRI reports comprising 13,388 exams was reviewed. Objective reporting timestamps were used to calculate RT. A natural language processing (NLP) tool was used to extract radiologist-assigned stenosis severity using a 6-point scale (0 = “normal” to 5 = “severe”) at each lumbar level. The composite severity score (CSS) was calculated as the sum of each of 18 stenosis grades. The predictive values of CSS, sex, age, radiologist identity, and referring service on RT were examined with multiple regression models. The NLP tool accurately classified LSDD in 94.8% of cases in a validation set. The CSS increased with patient age and differed between men and women. In a univariable model, CSS was a significant predictor of mean RT (R2 = 0.38, p p R2 = 0.83, p 25, R2 = 0.15, p = 0.05). Individual radiologist study volume was negatively correlated with mean RT (Pearson’s R = − 0.35, p

The US Preventive Services Task Force (USPSTF) recommends 1-time sonographic screening for abdominal aortic aneurysms (AAAs) in male smokers ages 65-75 and other selected individuals in this age group based on risk factors. Patients in this age range are frequent utilizers of lumbar spine MRI, in which the abdominal aorta is typically fully imaged. The purpose of this study was to assess the potential detection rate of AAAs on lumbar spine MRI performed in the USPSTF screening age range with systematic aortic measurement and the frequency with which AAAs are currently reported in practice.All consecutive lumbar spine MRI exams performed without contrast at a single academic tertiary care center over a 1-year period (4/1/2016-3/31/2017) in patients ages 65-75 were retrospectively reviewed. Maximal anteroposterior, and transverse dimensions of the abdominal aorta were measured using axial T2-weighted images, supplemented with sagittal T2-weighted images if assessment was limited by field-of-view or artifact. The detection rate of AAA, defined as dilation of the aorta to a diameter of ≥3 cm, size of AAAs detected, and frequency with which AAAs were reported, were assessed. Differences in aortic diameters and aneurysm detection rates between genders were compared with the unpaired 2-sample t test.Three hundred and ninety-five lumbar spine MRIs were reviewed, 240 (60.8%) in women and 155 (39.2%) in men, with mean ± standard deviation (SD) age of 70.2 ± 3.2 years. AAAs were detected in 38/395 (9.6%) cases, most (33/38, 86.8%) of which were4 cm. Of these, only 4 (10.5%) were reported by the interpreting radiologist; 3/4 (75%) corresponded to aneurysms ≥4 cm.Lumbar spine MRI performed in the USPSTF AAA screening age range, especially in men, facilitates frequent detection of AAA when the aorta is systematically measured. However, in typical lumbar spine assessment, AAAs are often underreported, particularly for smaller aneurysms.

Background and Purpose The purpose of this study is to assess the differences in degenerative spine MRI reporting between subspecialty-trained attending neuroradiologists and musculoskeletal radiologists (MSK) at a single institution, academic medical center. Materials and Methods Fifty consecutive outpatient noncontrast lumbar spine examinations were selected from the Picture Archiving and Communication System. Three MSK and 3 neuroradiologists (NR) independently reviewed and interpreted the exams at the L4-L5 and L5-S1 levels in the same manner as in clinical practice. The assessment of neural foraminal stenosis (NFS) and spinal canal stenosis (SCS) was converted to a 5-point ordinal scale. The assessment of lateral recess stenosis (LRS) and facet osteoarthritis (FO) was recorded as present/absent. Intersubspecialty and intrasubspecialty analysis was performed using Cohen's kappa coefficient with a binary matrix of all reader pairs. Results There was moderate intersubspecialty agreement (k = 0.527) for NFS and SCS (k = 0.540). Intersubspecialty agreement was slight for LRS (k = 0.0818) and FO (k = 0.176). The MSK group demonstrated greater intrasubspecialty agreement in assessment of NFS and SCS compared to the NR group, with nonoverlapping confidence intervals. The NR group demonstrated greater nominal intrasubspecialty agreement in the assessment of both LRS and FO, although with nonoverlapping confidence intervals. Conclusion There is moderate intersubspecialty agreement between MSK radiologists and neuroradiologists in reporting the severity of NFS and SCS, although MSK radiologists demonstrated greater intrasubspecialty agreement. There is slight intersubspecialty agreement for LRS and FO. The demonstration of differences in inter-reader agreement is a crucial first step to attempt to ameliorate these variabilities.

OBJECTIVE The aim of this study was to investigate the properties of psoas muscle in osteoporotic patients in lumbar magnetic resonance imaging (MRI) scan and their relationship with hip fracture. MATERIALS AND METHODS One hundred seventy-seven patients with osteoporosis (63.69 ± 9.677, 105 female) who had received lumbar spine MRI and dual-energy X-ray absorptiometry (DXA) examinations were retrospectively included. Thickness (PMT), cross-sectional areas (CSA), and index (PMI) values were measured for psoas muscle at L3 level and psoas muscle characteristics were compared between hip fracture and control groups. RESULTS PMT, CSA, and PMI values were statistically significantly different between hip fracture and control groups (respectively p

Background As rates of advanced imaging for lower back pain (LBP) continue to increase, there is a need to ensure the appropriateness of imaging. Objective The goal of this project was to reduce the number of inappropriate magnetic resonance imaging (MRI) and computed tomography (CT) requests for LBP patients and facilitate appropriate imaging by developing a combined imaging appropriateness checklist for lumbar spine MRI and CT. Methods In prior work, we developed and adopted individual evidence-based lumbar spine MRI and CT checklists into the radiology requisition process. In the current project, a combined checklist was developed and trialed in one of the former Saskatchewan health regions (Five Hills) beginning in May 2018. Using statistical process control, control charts compared the monthly number of imaging requests pre-checklist implementation and post-checklist implementation from May 2017 to February 2020. The monthly number of lumbar spine MRI and CT requisitions in the nearby former Saskatchewan Regina Qu’Appelle Health Region, in which the combined checklist was not trialed, was also plotted and compared as a balancing measure. Results In Five Hills, a shift (decrease) was observed in the monthly number of lumbar spine MRI requisitions 7 months following the implementation of the combined checklist. However, the monthly number of lumbar spine CT requisitions did not change significantly. In the Regina Qu’Appelle Health Region, there was a shift (increase) in the monthly number of lumbar spine MRI requisitions, while the monthly number of lumbar spine CT requests decreased after the implementation of the combined checklist. Conclusions The combined checklist with evidence-based indications for lumbar spine MRI and CT imaging in LBP patients appeared to reduce the complexity associated with two previous individual checklists and facilitate imaging appropriateness. Accountable benefits may include the reduction of radiation exposure as a result of unnecessary and repeated imaging and reduction in wait times for CT and/or MRI.

Background Assessment of lumbar spinal stenosis at MRI is repetitive and time consuming. Deep learning (DL) could improve -productivity and the consistency of reporting. Purpose To develop a DL model for automated detection and classification of lumbar central canal, lateral recess, and neural -foraminal stenosis. Materials and Methods In this retrospective study, lumbar spine MRI scans obtained from September 2015 to September 2018 were included. Studies of patients with spinal instrumentation or studies with suboptimal image quality, as well as postgadolinium studies and studies of patients with scoliosis, were excluded. Axial T2-weighted and sagittal T1-weighted images were used. Studies were split into an internal training set (80%), validation set (9%), and test set (11%). Training data were labeled by four radiologists using predefined gradings (normal, mild, moderate, and severe). A two-component DL model was developed. First, a convolutional neural network (CNN) was trained to detect the region of interest (ROI), with a second CNN for classification. An internal test set was labeled by a musculoskeletal radiologist with 31 years of experience (reference standard) and two subspecialist radiologists (radiologist 1: A.M., 5 years of experience; radiologist 2: J.T.P.D.H., 9 years of experience). DL model performance on an external test set was evaluated. Detection recall (in percentage), interrater agreement (Gwet κ), sensitivity, and specificity were calculated. Results Overall, 446 MRI lumbar spine studies were analyzed (446 patients; mean age ± standard deviation, 52 years ± 19; 240 women), with 396 patients in the training (80%) and validation (9%) sets and 50 (11%) in the internal test set. For internal testing, DL model and radiologist central canal recall were greater than 99%, with reduced neural foramina recall for the DL model (84.5%) and radiologist 1 (83.9%) compared with radiologist 2 (97.1%) (

Introduction Interpretation of a lumbar spine MRI in the immediate postoperative period is challenging, as postoperative tissue enhancement and fluid collections may be mistaken for infection. Radiology reports may use ambiguous language, creating a clinical problem for a surgeon in determining whether a patient needs treatment with antibiotics or revision surgery. Moreover, retrospective criticism of management in instances of a true infection may lead to medicolegal ramifications. Methods A retrospective review of patients undergoing posterior-approach lumbar decompressive surgery with or without fusion over a 30-month period identified those undergoing postoperative MRI within 10 weeks of surgery. Patients initially operated upon for infection were excluded. The MRI reports were analyzed for language describing findings suspicious for infection and those of these with true infections were identified. Results Of 487 patients undergoing posterior lumbar spine decompression surgery, 68 (14%) had postoperative MRI within 10 weeks. Of these, the radiology reports raised suspicion for infection in 20 (29%), of which 2 (10%) patients had a true infection. Two patients underwent reoperation for new motor deficit from seroma/hematoma. Of 63 patients who had MRI to evaluate complaints of back and/or leg pain without new motor deficits, the MRI significantly altered management in 3 patients (4.8%). Conclusion Radiology reports of postoperative lumbar spine MRIs frequently use language that raises suspicion for infection; but it is uncommon, however, that these patients harbor true infections. A radiology report describing possible infectious findings may not be considered significant without corroboration with other laboratory and clinical data.

To assess extraspinal findings (ESFs) prevalence in lumbar spine MRI, including clinically significant findings using a systematic approach, and to determine their reporting rate. Lumbar spine MRI scans were retrospectively reviewed over 18 months by two radiologists. Reading discrepancies were resolved by consensus. ESFs were classified according to the involved system, clinical diagnosis, and clinical significance. The reporting rate was estimated by referring to the original report. There were 1509 ESFs in 1322/4250 patients with a substantial agreement between the two radiologists (kappa = 0.8). Almost half (621/1322) were in the 45–60 age group. Females represented 56.6% (748/1322). 74.2% (1120/1509) of the ESFs involved the urinary system among which 79.6% (892/1120) were renal cysts. Clinically significant findings represented 8.7% (131/1509) among which hydronephrosis represented 23% (30/131). First time detected malignant lesions represented 4.6% (6/131). ESFs reporting rate was 47.3%. 58.8% of the clinically significant ESFs were not reported. ESFs prevalence was 31.1%. The Urinary system was the most commonly involved. Most ESFs were benign warranting no further workup. However, clinically significant ESF were not infrequently detected. More than half of the clinically significant findings were not reported. A systematic review of MRI images is highly recommended to improve patient’s outcome.

Background Scout images of lumbar spine MRI often include the extraspinal organs, which are barely included in routine MRI and can be a potential cause of lumbar pain. Purpose To evaluate the readability of scout images for extraspinal organs in lumbar spine MRI according to different protocols. Materials and methods A total of 150 patients who underwent 1.5 T or 3 T lumbar spine MRI from March to September 2015 at three hospitals with different scout image protocols, were selected. Two radiologists independently reviewed the scout images to investigate whether exclusive diagnosis of major diseases involving the femoral head, femoral neck, sacroiliac joint, and kidneys was possible. Readability levels were divided into four categories: definitely, possibly, limited, and non-evaluable. The readability of scout images according to the protocols was compared using Chi-square test. Interobserver agreement for the readability level of scout images was assessed using weighted κ statistics. Results Of 150 patients, “definitely evaluable” cases classified by two readers were 50–62 (33.3–41.3%) for femoral head (κ = 0.63–0.71), 37–66 (24.7–44.0%) for femoral neck (κ = 0.41–0.48), 72–93 (48.0–62.0%) for sacroiliac joint (κ = 0.35–0.37), and 63–73 (42.0–48.7%) for kidneys (κ = 0.45–0.47). More than 50% of femoral heads were classified as readable (definitely or possible evaluable) cases by two readers with excellent interobserver agreement. The readability level of scout images was significantly different according to image protocols including the MRI sequence, number of coronal plane slices, and intersection gap of coronal plane slices (p≤0.015). Conclusion Scout images of lumbar spine MRI may be readable enough to rule out some major diseases of extraspinal organs. Standardization of the protocol will be needed to validate the potential role of scout images for screening extraspinal organs.

BackgroundSpondylolisthesis is often misdiagnosed on magnetic resonance imaging (MRI) as the slip may reduce to a normal alignment when the patient lies supine. Often, disc herniation is reported at the level of spondylolisthesis.PurposeTo determine the incidence rates of disc herniation at the level of spondylolisthesis.Material and MethodsThis is a retrospective study included 258 consecutive patients with spondylolisthesis who had lumbar spine MRI. The archived reports were collectively put in Group 1. A musculoskeletal radiologist and a spine surgeon reviewed the imaging studies together. Their readings were referred to as Group 2. The findings of both groups were compared to evaluate whether disc herniation was overreported.ResultsGroup 1 reported findings of true disc herniation in 112 (41.6%) cases and pseudo disc herniation or no findings of disc herniation at the level of spondylolisthesis in 157 (58.4%) cases. Group 2 reported findings of a true disc herniation in 25 (9.3%) cases and pseudo disc herniation or no findings of disc herniation in the remaining 244 (90.7%) cases. There was a statistically significant difference in the reporting rates between these two groups ( P ConclusionThe current study showed overreporting of disc herniation in lumbar spine MRI scans performed for patients with established spondylolisthesis. The majority of disc pathology at the level of spondylolisthesis are pseudo disc rather than a true disc herniation. An accurate diagnosis is vital in planning surgical intervention.

Aim: To investigate the prevalence and reporting rates of incidental findings (IF) in the routine magnetic resonance imaging(MRI) of the lumbar spine, and to emphasize their clinical importance. Methods: A total of 4012 lumbar MRI taken between January 2014 and December 2016 were reevaluated. The low back pain and sciatalgia those suspected for lumbar spinal pathology were chosen for this study. Extra-spinal abnormalities were classified according to a modified CT Colonography Reporting and Data System (C-RADS) and analyzed. Results The mean age of patients was 49, 83 (range 17-87) years. Of the cases, 2472 were women and 1540 were men. In 3834 cases, disk pathology was observed. In 1282 cases extraspinal pathology was detected. The largest group in the study consisted of C-RADS E2 with 1048 patients (82.5%). There were 195 patients (28.3%) in the C-RADS E3 group and 23 (1.8%) patients in the C-RADS E4 group, potentially important. Conclusion: Our results show that random extra-spinal abnormalities in the lumbar spine MRI, are very common and systematic evaluation and proper reporting of MRI are crucial.

Background: A minimally invasive approach to the L2-S1 disc spaces through a single, left-sided, retroperitoneal oblique corridor has been previously described. However, the size of this corridor varies, limiting access to the disc space in certain patients. Here, the authors retrospectively reviewed lumbar spine magnetic resonance imaging (MRI) in 300 patients to better define the size and variability of the retroperitoneal oblique corridor. Methods: Lumbar spine MRI from 300 patients was reviewed. The size of the retroperitoneal oblique corridor from L2-S1 was measured. It was defined as the (1) distance between the medial aspect of the aorta and the lateral aspect of the psoas muscle from L2-L5 and (2) the distance between the midpoint of the L5-S1 disc and the medial aspect of the nearest major vessel on the left at L5-S1. In addition, the rostral-caudal location of the iliac bifurcation was measured. Results: The size of the retroperitoneal oblique corridor at L2/3, L3/4, L4/5, and L5/S1 was, respectively, 17.3 ± 6.4 mm, 16.2 ± 6.3 mm, 14.8 ± 7.8 cm, and 13.0 ± 8.3 mm. The incidence of corridor size n = 158, 52.67%) followed by the L4/5 disc space (n = 74, 24.67%). Conclusion: The size of the retroperitoneal oblique corridor diminishes in a rostral-caudal direction, often limiting access to the L4/5 and L5/S1 disc spaces.

Objectives: Magnetic resonance imaging has proven to be a valuable tool in the assessment of disc abnormalities. Two types of disc extrusion can be described according to the direction of herniated disc material: shoulder type and axillary type. Axillary disc herniation is described when the extruded disc fragment lies in the recess between the lateral border of cauda equina and medial to the nerve roots, while in the shoulder type the disc lies lateral to the nerve roots. It is very important to describe the type of disc herniation, as the surgical approach differs in each type. To the best of the authors' knowledge, no definite signs have been described in literature to date. This study aimed to address the accuracy of the kissing sign on MRI for he diagnosis of axillary disc herniation. Methods: The MRIs of 72 patients undergoing spinal surgery were prospectively evaluated for axillary disc herniation by a senior radiologist and experienced spinal surgeon using the kissing sign on MRI. The kissing sign was considered positive when the herniated disc material was in direct contact with the lamina and/or ligamentum flavum on axial images. Subsequently, all surgeries were performed by two independent surgeons and the actual type of disc herniation was documented. The accuracy of the results was statistically assessed. Results: The kissing sign on MRI was found to be 66.66% sensitive, 92.59% specific, and 76.38% accurate in detecting axillary disc herniation with significant correlation with the surgical findings. Conclusion: The type of disc herniation is an important parameter for patient selection in different surgical approaches. The kissing sign on MRI can be considered as an important tool for diagnosing axillary disc herniation due to its high specificity and accuracy. RESUMO Objetivos: A ressonância magnética provou ser uma ferramenta valiosa na avaliação das anormalidades do disco. Dois tipos de extrusão de disco podem ser descritos de acordo com a direção do disco herniado: lateral e axilar. A hérnia de disco axilar é definida quando o fragmento do disco extruso encontra-se no recesso entre a borda lateral da cauda equina e medial às raízes do nervo, enquanto na hérnia lateral o disco posiciona-se lateralmente às raízes do nervo. A descrição do tipo de hérnia de disco é extremamente importante, pois a abordagem cirúrgica difere em cada tipo. Tanto quanto é do conhecimento dos autores, nenhum sinal definido foi descrito na literatura até o momento. Este estudo teve como objetivo abordar a precisão do sinal do beijo na RM no diagnóstico de herniação de disco axilar. Métodos: As RM de 72 pacientes submetidos à cirurgia da coluna vertebral foram avaliadas prospectivamente em relação à presença de hérnia de disco axilar por um radiologista sênior e cirurgião da coluna experiente com o sinal do beijo na RM. O sinal do beijo foi considerado positivo quando o material do disco herniado estava em contato direto com a lâmina e/ou ligamento amarelo em imagens axiais. Posteriormente, todas as cirurgias foram feitas por dois cirurgiões independentes e o tipo real de hérnia de disco foi documentado. A precisão dos resultados foi avaliada estatisticamente. Resultados: O sinal do beijo na RM apresentou 66,66% de sensibilidade, 92,59% de especificidade e 76,38% de precisão na detecção de hérnia de disco axilar com correlação significativa com os achados cirúrgicos. Conclusão: O tipo de hérnia de disco é um parâmetro importante para a seleção de pacientes em diferentes abordagens cirúrgicas. O sinal do beijo na RM pode ser considerado uma ferramenta importante para o diagnóstico de hérnia de disco axilar devido à sua alta especificidade e precisão.

In an overall human population, maximum number of adults suffers from back pain. Low back pain in any individual will greatly affect their daily routine. Recent Developments of Bio Science and the superior availability of Computer Technology enabled abundant active researches combining digital technologies like magnetic resonance imaging (MRI) with finite element analysis (FEA) offer better diagnosis and treatment options. Clinically, lumbar degenerative disc disease (LDDD) is of the main reason for low back pain. Degenerative disc disease in the lumbar region of the lower back is due to a compromised disc leading to low back pain. Aging and overloading factors are also some of the causes for low back pain. Once the chronic disc problem has been diagnosed, the conservative treatments like: specific rest, friction force medical aid or physiotherapy and exercise are followed. When correctly diagnosed, an excessive amount of medical/surgical treatments can be avoided. The aim of the study is to generate a mesh model and numerically simulate the biomechanical characteristics of the human spine, namely two vertebrae (L4 and L5) and inter vertebrae disc using finite element analysis (FEA) technique. In this process the bony areas of every MRI scanned image is segmented and the boundary lines are stacked into a smooth surface. Additionally, the technique generates the quantity mesh exploitation linear unit that is used to process the mesh for agreement. Moreover, L4 and L5 with disc were considered as linear materials with the exception of the ligaments. The contact behaviour of the two bones, simulation of disc and obtained displacements and stress describe about the pre-operation of human lumbar spine. The results depict that the potential fracture of the considered patient with respect to displacements. In this paper the implementation of various filtering techniques like median filter technique, Wiener filter technique and bilateral filter technique have been discussed. Using various edge detection algorithms namely, Canny edge detection, Sobel edge detection, Prewitt edge detection and Roberts edge detection, the results were compared. Among them, spine Canny edge detection algorithm produced effective output using MATLAB estimating the following parameters like total deformation, equivalent elastic strain, maximum and minimum principal elastic strain, normal elastic strain, shear elastic strain, equivalent stress, maximum and minimum principal stress, normal stress and shear stress. With the help of these parameters, the human spine model was analyzed and computed under different conditions at various degree of angles like 30°, 60° and 90° using the simulation software ANSYS and CATIA. The implementation has done with MATLAB, whereas the stress and strain have been found at the plate bone of aspect joint of L4 and L5.

BACKGROUND AND PURPOSE Previous studies have used parallel imaging (PI) techniques to decrease spine magnetic resonance imaging (MRI) protocol acquisition times. Recently developed MRI sequences allow even faster acquisitions. Our purpose was to develop a lumbar spine MRI protocol using PI with GRAPPA (generalized autocalibrating partially parallel acquisition) and a simultaneous multislice (SMS)–based sequence and to evaluate its diagnostic performance compared to a standard lumbar spine MRI protocol. METHODS Ten patients were scanned in a 3-Tesla scanner (MAGNETOM Skyra, Siemens Healthcare). Each patient was imaged using a standard protocol and an optimized fast protocol acquiring the same contrasts and planes. The fast protocol included sagittal T1, T2, and fat suppressed T2 sequences accelerated with GRAPPA and an SMS-based axial T2-weighted sequence using a high-density spine coil (Siemens MR, 30 channel spine). Two blinded neuroradiologists independently assessed image quality and diagnostic accuracy for clinically relevant imaging findings. RESULTS The fast protocol acquisition time was 5:28 minutes, compared with 16:30 minutes for the standard protocol. Both protocols had a similar performance for definition of anatomical structures, diagnostic quality, and identification of clinically relevant imaging findings. There were more artifacts in the SMS Turbo Spin Echo (P = .014) sequence without compromising diagnostic performance. Artifacts in the remaining non-SMS sequences were similar in both protocols (P > .180). The sensitivity, specificity, and accuracy of the 5-minute protocol were 92.3%, 100.0%, and 99.6%, respectively, for the clinically relevant findings (P = 1.0, interrater agreement .57). CONCLUSIONS A 5-minute SMS-based MRI protocol for lumbar spine imaging is feasible and can be achieved without significant impact in the overall diagnostic quality.

Background Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood. Objective To characterize and explain the factors contributing to PCPs ordering unneeded LS-MRI for acute, uncomplicated low-back pain. Design Qualitative study using semi-structured interviews. Participants Veterans Affairs PCPs identified from administrative data as having high or low rates of guideline-concordant LS-MRI ordering in 2016. Approach Providers were interviewed about their use of LS-MRI for acute, uncomplicated low-back pain and factors contributing to their decision-making. Directed content analysis of transcripts was conducted to identify and compare environmental-, patient-, and provider-level factors contributing to unneeded LS-MRI. Key Results Fifty-five PCPs participated (8.6% response rate). Both low (n = 33) and high (n = 22) guideline-concordant providers reported that LS-MRIs were required for specialty care referrals, but they differed in how other environmental factors (stringency of radiology utilization review, management of patient travel burden, and time constraints) contributed to LS-MRI ordering patterns. Low- and high-guideline-concordant providers reported similar patient factors (beliefs in value of imaging and pressure on providers). However, provider groups differed in how provider-level factors (guideline familiarity and agreement, the extent to which they acquiesced to patients, and belief in the value of LS-MRI) contributed to LS-MRI ordering patterns. Conclusions Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI. Electronic supplementary material The online version of this article (10.1007/s11606-019-05410-y) contains supplementary material, which is available to authorized users.

Background To document the prevalence of extra spinal findings in lumbar MRI Results Among the scanned 400 patients, 90 cases had incidental non-spinal findings, and in 30 out of these 90 patients, the finding was the only reason for their complaint. Conclusions Radiologists should give attention to the non-spinal findings in lumbar spine MRI, as the detected pathology could be the source of pain or could potential life-threatening conditions.

Chronic Lower Back Pain (CLBP) is one of the major types of pain that is affecting many people around the world. Lumbar Spine Stenosis (LSS), a major cause of CLBP, requires experienced neuroradiologists to detect and diagnose. It has been reported that the number of MRI examinations around the world is increasing but the number of specialist neuroradiologists to examine and analyse them has not. This paper presents a continuation of our methodology to automatically detect the presence of LSS by analyzing lumbar spine MRI images. It details important points location-determination algorithm that can be further processed in the LSS diagnosis procedure. We use the results of our, previously developed, boundary delineation method to supply boundary points to the algorithm. The algorithm is applied to the best cut axial-view images of the intervertebral discs of 515 patients contained in the Lumbar Spine MRI dataset. The results of the important points locations are presented.

The aim was to elucidate elite swimming’s possible influence on lumbar disc degeneration (DD) and low back pain (LBP). Lumbar spine MRI was performed on a group of elite swimmers and compared to a matched Finnish population-based no-sport group. One hundred elite swimmers and 96 no-sport adults, mean age 18.7/20.8, respectively, participated. Overall, the two groups had similar prevalence of DD. Swimmers had more DD in the upper lumbar spine but tended to have less DD at the lowest level. Prevalence of bulges and disc herniations were similar, but swimmers had significantly more bulges at L4–5. The swimmers reported less LBP, although not significantly (N.S.). If degenerative findings were present, the association between them and LBP was stronger in the no-sport group. Elite swimmers and controls had similar prevalence of DD and LBP, although the pattern of DD differed between the groups. In case of DD, swimmers reported less LBP, although N.S.

Objective Radiology reports have traditionally been written for referring clinical providers. However, as patients increasingly access their radiology reports through online medical records, concerns have been raised about their ability to comprehend these complex documents. The purpose of this study was to assess the readability of lumbar spine MRI reports. Materials and methods We reviewed 110 lumbar spine MRI reports dictated by 11 fellowship-trained radiologists (eight musculoskeletal radiologists and three neuroradiologists) at a single academic medical center. We evaluated each article for readability using five quantitative readability tests: the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index, and the Simple Measure of Gobbledygook. The number of reports with readability at or below eighth-grade level (average reading ability of U.S. adults) and at or below sixth-grade level (level recommended by the National Institutes of Health and the American Medical Association for patient education materials) were determined. Results The mean readability grade level of the lumbar spine MRI reports was greater than the 12th-grade reading level for all readability scales. Only one report was written at or below eighth-grade level; no reports were written at or below sixth-grade level. Conclusion Lumbar spine MRI reports are written at a level too high for the average patient to comprehend. As patients increasingly read their radiology reports through online portals, consideration should be made of patients' ability to read and comprehend these complex medical documents.

MRI is considered the gold standard in soft tissue diagnostic of the lumbar spine. Number of protocols and modalities are used – from one hand 2D sagittal, 2D angulated axial, 2D consecutive axial and 3D image types; from the other hand different sequences and contrasts are used: T1w, T2w; fat suppression, water suppression etc. Images of different modalities are not always aligned. Resolutions and field of view also vary. SNR is also different for different MRI equipment. So the goal should be to create an algorithm that covers great variety of imaging techniques.

The purpose of this study is to determine whether the type of feedback on evidence-based guideline adherence influences adult primary care provider (PCP) lumbar spine (LS) MRI orders for low back pain (LBP).Four types of guideline adherence feedback were tested on eight tertiary health care system outpatient PCP practices: no feedback during baseline (March 1, 2012-October 4, 2012), randomization by practice to either clinical decision support (CDS)-generated report cards comparing providers to peers only or real-time CDS alerts at order entry during intervention 1 (February 6, 2013-December 31, 2013), and both feedback types for all practices during intervention 2 (January 14, 2014-June 20, 2014, and September 4, 2014-January 21, 2015). International Classification of Disease codes identified LBP visits (excluding Medicare fee-for-service). The primary outcome of the likelihood of LS MRI order being made on the day of or 1-30 days after the outpatient LBP visit was adjusted by feedback type (none, report cards only, real-time alerts only, or both); patient age, sex, race, and insurance status; and provider sex and experience.Half of PCPs (54/108) remained for all three periods, conducting 9394 of 107,938 (8.7%) outpatient LBP visits. The proportion of LBP visits increased over the course of the study (p = 0.0001). In multilevel hierarchic regression, report cards resulted in a lower likelihood of LS MRI orders made the day of and 1-30 days after the visit versus baseline: 38% (p = 0.009) and 37% (p = 0.006) for report cards alone, and 27% (p = 0.020) and 27% (p = 0.016) with alerts, respectively. Real-time alerts alone did not affect MRI orders made the day of (p = 0.585) or 1-30 days after (p = 0.650) the visit. No patient or provider variables were associated with LS MRI orders being generated on the day of or 1-30 days after the LBP visit.CDS-generated evidence-based report cards can substantially reduce outpatient PCP LS MRI orders on the day of and 1-30 days after the LBP visit. Real-time CDS alerts do not.

Purpose To compare tridimensional (3D) T2-weighted spin-echo MRI and CT for minimal pedicle width measurements in the preoperative assessment of adolescent idiopathic scoliosis (AIS) in adolescent and young patients. Materials and methods A total of 22 adolescents/young patients suffering from AIS were retrospectively included. There were 18 females and 4 males with a mean age of 15.3 ± 2.3 (SD) years (range: 11–21 years). Preoperative lumbar spine MRI and CT examinations of the 22 patients were reviewed by two independent readers who measured the minimal width of 259 pedicles. Inter-reader agreement for CT and MRI was assessed using intra-class correlation coefficient (ICC). Intra-reader agreement and relative differences in measurements between MRI and CT were also assessed for each reader. Results Inter-reader agreement was excellent (ICC ≥ 0.8) for both CT and MRI. Relative differences in measurements between CT and MRI was 10.3% for reader 1 and 9.4% for reader 2. Conclusion 3D T2-weighted spin-echo MRI underestimates minimal pedicle width by only 9.4 - 10.3% compared to CT. 3D T2-weighted MRI appears as a valuable alternative to CT for preoperative measurements of vertebral pedicles in AIS.

This paper addresses the central problem of automatic segmentation of lumbar spine Magnetic Resonance Imaging (MRI) images to delineate boundaries between the anterior arch and posterior arch of the lumbar spine. This is necessary to efficiently detect the occurrence of lumbar spinal stenosis as a leading cause of Chronic Lower Back Pain. A patch-based classification neural network consisting of convolutional and fully connected layers is used to classify and label pixels in MRI images. The classifier is trained using overlapping patches of size 25x25 pixels taken from a set of cropped axial-view T2-weighted MRI images of the bottom three intervertebral discs. A set of experiment is conducted to measure the performance of the classification network in segmenting the images when either all or each of the discs separately is used. Using pixel accuracy, mean accuracy, mean Intersection over Union (IoU), and frequency weighted IoU as the performance metrics we have shown that our approach produces better segmentation results than eleven other pixel classifiers. Furthermore, our experiment result also indicates that our approach produces more accurate delineation of all important boundaries and making it best suited for the subsequent stage of lumbar spinal stenosis detection.

The purpose of this study was to determine reliable MRI findings suggesting disk herniation with cartilage endplate herniation in the lumbar spine.The records of 73 patients who underwent lumbar spinal MRI and lumbar microdiskectomy between March 2005 and January 2009 were searched to find those with the diagnosis of disk herniation with cartilage endplate herniation confirmed during surgery. The following morphologic features were assessed: posterior corners (posterior marginal nodes, dorsal corner defects, Modic changes, and posterior osteophytes), mid endplates (endplate irregularities, Modic changes), and heterogeneous low signal intensity of extruded material. The chi-square test and multiple logistic regression analysis with age, body mass index, and sex as covariates were used for the analysis. The ROC curve was obtained with scores of the statistically significant MRI findings.Posterior marginal nodes, posterior osteophytes, Modic changes in posterior corners, mid endplate irregularities, Modic changes in mid endplates, and heterogeneous low signal intensity of extruded material were significantly more frequent in patients with disk herniation with cartilage endplate herniation (0.000p0.009). The AUC for diagnosing disk herniation with cartilage endplate herniation with our scoring system of the six MRI findings (0-6) was 0.888.The presence of disk herniation with cartilage endplate herniation could be ascertained with the following MRI findings: posterior marginal nodes, posterior osteophytes, mid endplate irregularities, heterogeneous low signal intensity of extruded material, and Modic changes in posterior corners and mid endplates.

To assess the performance of fat-suppressed fluid-sensitive MRI sequences compared to T1-weighted (T1w) / T2w sequences for the detection of Modic 1 end-plate changes on lumbar spine MRI.Sagittal T1w, T2w, and fat-suppressed fluid-sensitive MRI images of 100 consecutive patients (consequently 500 vertebral segments; 52 female, mean age 74 ± 7.4 years; 48 male, mean age 71 ± 6.3 years) were retrospectively evaluated. We recorded the presence (yes/no) and extension (i. e., Likert-scale of height, volume, and end-plate extension) of Modic I changes in T1w/T2w sequences and compared the results to fat-suppressed fluid-sensitive sequences (McNemar/Wilcoxon-signed-rank test).Fat-suppressed fluid-sensitive sequences revealed significantly more Modic I changes compared to T1w/T2w sequences (156 vs. 93 segments, respectively; p 0.001). The extension of Modic I changes in fat-suppressed fluid-sensitive sequences was significantly larger compared to T1w/T2w sequences (height: 2.53 ± 0.82 vs. 2.27 ± 0.79, volume: 2.35 ± 0.76 vs. 2.1 ± 0.65, end-plate: 2.46 ± 0.76 vs. 2.19 ± 0.81), (p 0.05). Modic I changes that were only visible in fat-suppressed fluid-sensitive sequences but not in T1w/T2w sequences were significantly smaller compared to Modic I changes that were also visible in T1w/T2w sequences (p 0.05).In conclusion, fat-suppressed fluid-sensitive MRI sequences revealed significantly more Modic I end-plate changes and demonstrated a greater extent compared to standard T1w/T2w imaging.· When the Modic classification was defined in 1988, T2w sequences were heavily T2-weighted and thus virtually fat-suppressed.. · Nowadays, the bright fat signal in T2w images masks edema-like changes.. · The conventional definition of Modic I changes is not fully applicable anymore.. · Fat-suppressed fluid-sensitive MRI sequences revealed more/greater extent of Modic I changes..· Finkenstaedt T, Del Grande F, Bolog N et al. Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences. Fortschr Röntgenstr 2018; 190: 152 - 160.ZIEL: Ziel der Studie ist es, die Detektionsrate von Modic-Typ-1-Endplattenveränderungen mittels fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen gegenüber Standard T1- und T2-gewichteten Sequenzen an der Lendenwirbelsäule zu vergleichen.Sagittale T1, T2 und fettgesättigte, flüssigkeitssensitive MRT-Sequenzen von 100 Patienten (gesamt 500 Wirbelsegmente; 52 weiblich, Durchschnittsalter 74 ± 7,4 Jahre; 48 männlich, Durchschnittsalter 71 ± 6,3 Jahre) wurden retrospektiv untersucht. Das Vorhandensein (ja/nein) und die Ausdehnung (Likert-skalierte Höhen-, Volumen- und anteroposteriore Endplattenausdehnung) von Modic-1-Veränderungen auf T1/T2 gegenüber fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen wurden analysiert (McNemar/Wilcoxon-signed-rank test).Mittels fettgesättigter, flüssigkeitssensitiver MRT-Sequenzen konnten signifikant mehr Modic-1-Veränderungen detektiert werden als mittels T1-/T2-Sequenzen (156 vs. 93 Segmente; p 0,001). Die Ausdehnung von Modic-1-Veränderungen auf fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen war signifikant größer gegenüber T1-/T2-Sequenzen (Höhe: 2,53 ± 0,82 vs. 2,27 ± 0,79, Volumen: 2,35 ± 0,76 vs. 2,1 ± 0,65, Endplattenausdehnung: 2,46 ± 0,76 vs. 2,19 ± 0,81), (p 0,05). Modic-1-Veränderungen, die nur auf fettgesättigten, flüssigkeitssensitiven Sequenzen, aber nicht auf T1-/T2-Sequenzen detektiert werden konnten, waren signifikant kleiner im Vergleich zu Modic-1-Veränderungen, die auch auf T1-/T2-Sequenzen sichtbar waren (p 0,05).Fettgesättigte, flüssigkeitssensitive Sequenzen haben nicht nur signifikant häufiger Modic-1-Veränderungen, sondern auch eine größere Ausdehnung ebendieser gegenüber Standard T1-/T2-Sequenzen nachweisen können.· Als die Modic-Klassifikation 1988 definiert wurde, waren T2-Sequenzen technisch bedingt nahezu fettgesättigt. · Fettsignal aktueller T2-Sequenzen ist deutlich heller, wodurch zusätzliches Knochenmarksödem maskiert werden kann. · Die ursprüngliche Definition von Modic-1-Veränderungen ist daher heutzutage nicht mehr zutreffend. · Fettgesättigte, flüssigkeitssensitive Sequenzen haben häufiger/größere Ausdehnung von Modic-1-Veränderungen gegenüber T1-/T2-Sequenzen nachweisen können.