MRI Overcall

MRI overcall
Title: Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects

Reference: Boden, S, et al. JBJS 72A, No. 3, March 1990

Main Message

Abnormalities on MRI are common in asymptomatic people (up to 30%!!) – particularly in the elderly. Caution must therefore be applied before using the MRI data to base clinical decisions on.

Points of Interest

This is a great study which asks the question of whether the MRI is specific enough, given the fact that there is a high incidence of abnormal findings on discograms, myelograms, and CT. Looked also at interobserver reliability amongst the radiologists who read the films, and found this to be excellent.

Examined 67 asymptomatic volunteers.
– in total, 16 (28%) had substantially abnormal findings.
– in the 35 20-39 year olds, 20 % had findings
– in the 18 40-59 year olds, 22% had findings
– in the 14 60-80 year olds, 57% had findings!

– the most common abnormalities in the older group were herniated nucleus pulposus and stenosis
– the “bulging disc” was VERY common – 54% of the 60 yr olds
– the “degenerative disc” was almost universal in the elderly – only 12% in the 60 year olds.

– An abnormal MR in a young patients is more likely to be a true indication of the cause of complaints.

– The findings of bulging disc and degeneration are part of a normal, or at least common, aging process.

Thoughts….

Really interesting paper. Makes you think twice about the “radiographic interpretation” – the information must be correlated clinically.