Accuracy of magnetic resonance imaging in detecting lumbo-sacral nerve root compromise: a systematic literature review.

Nassib Tawa,Anthea Rhoda,Ina Diener

doi:10.1186/s12891-016-1236-z

Abstract

BackgroundMRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy. There exists controversy among researchers and clinicians regarding the diagnostic utility and accuracy of MRI in detecting nerve root compromise and radiculopathy. This review evaluated 4 primary diagnostic accuracy studies that specifically assessed the accuracy of MRI in detecting nerve root compromise, as established in the current literature.MethodsEight electronic data bases were searched for relevant articles from inception until January 2014. All primary diagnostic studies which investigated the accuracy of MRI in diagnosing nerve root compromise among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the ‘Quality Assessment of Diagnostic tests Accuracy Studies’ criteria.ResultsFour studies qualified for inclusion in this review. The sensitivity of MRI in detecting lumbar nerve root compromise was very low at 0.25 (95 % CI) while the specificity was relatively high at 0.92 (95 % CI).ConclusionsThere is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy. Therefore, clinicians should always correlate the findings of MRI with the patients’ medical history and clinical presentation in clinical decision making.

Highlights

Magnetic resonance imaging (MRI) is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy
A discussion was held between the two reviewers (NT and ID) with adjudication by the third reviewer (AR) regarding the specific objectives of the eight remaining studies and a further four were excluded because their primary objective was to assess the accuracy of MRI in detecting disc herniation and not nerve root compromise
All four studies assessed the accuracy of MRI in detecting lumbar nerve root compromise among patients who presented with signs and symptoms consistent with LSR

Summary

Introduction

MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy. There exists controversy among researchers and clinicians regarding the diagnostic utility and accuracy of MRI in detecting nerve root compromise and radiculopathy. In the field of musculo-skeletal medicine, there have been reports of over-utilisation and overdependency on imaging, which has been attributed to among other reasons technological advances, availability of medical imaging, clinicians’ uncertainty and patients’ expectations [7]. These may all result from clinicians’ attempt to address the delicate balance between not missing a treatable pathology and avoiding unnecessary investigation which may increase patients’ fears about their condition [8].

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