Association of History Taking and Accuracy of the Interpretation of Cervical and Lumbar Magnetic Resonance Imaging

Abstract

BACKGROUND: Disk herniation leading to radiculopathy is one of the most important causes of neck and back pain, requiring specific diagnostic tests. Magnetic resonance imaging (MRI) is one of these diagnostic methods. Interpreting the findings of this imaging method by an experienced skilled person is very important.
 AIM: The purpose of this study was to investigate the role of history on the accuracy of the lumbar or cervical MRI reports in patients with back and neck pain referring to the radiology department.
 METHODS: This study was performed on patients with complaints of lumbar or neck pain that MRI had been performed for them. At first, the MRI was studied by the residents of the 2nd and 3rd years and then a radiologist as a routine, respectively. From 4 to 6 months later, patients’ clinical history was presented to the same students and professors and MRI was re-reported. Statistical differences were evaluated and analyzed using SPSS software version 20.
 RESULTS: Out of 150 patients with mean age of 42.56 ± 10.65, 87 patients (58%) were female and 63 (42%) were male. Most of the patients were between the ages of 40 and 50 years (34.66%). The most common clinical symptom of patients was waist and neck pain followed by sensory disturbances of the extremities. The most pathologic changes found was disk bulging in 28.8% of patients (68 cases). In terms of lumbar canal stenosis, the most cases were in the L4-L5 levels of the moderate type. The most reported cases of cervical stenosis have been mild. Disk herniation and DOCP were two main factors causing canal stenosis in the study patients. Statistical difference in the MRI reports performed by the residents on most of the variables was statistically significant before and after knowing the clinical history of the patient (p < 0.05). However, this difference was less noted in the reports of the radiologists.
 CONCLUSION: The results of this study showed that knowing the history of patients in interpreting the results of MRI in patients with vertebral disk hernia is misleading and will lead to many false positive and negative results, especially for radiology residents. It is recommended that the residents and radiologists consider the MRI films before focusing on the biographies and clinical features of the patient, to prevent the occurrence of bias and to increase the accuracy of the reports.