Pub Date : 2023-11-01DOI: 10.1016/j.rxeng.2023.07.003
F. Sendra Portero , D. Domínguez Pinos , M. Souto Bayarri
Radiology is now an essential part of Clinical Medicine, but undergraduate training does not reflect its importance in medical practice. In the current course, there are 46 medical schools in our country. According to the information published on the institutional websites, the study plans are very different in terms of the presence of Diagnostic Radiology and the organization of teaching. The estimated number of teaching hours in diagnostic radiology (mean ± standard deviation) is 61.3 ± 22.2 h (range from 26 h to 137 h). There is a great shortage of clinical university professors, and a generational change is essential. The current situation poses various challenges, including adapting to new teaching methods and technologies and promoting the presence of radiology in medical study plans, paying special attention to hospital practices, the Final Degree Project (FDP) and the Objective Structured Clinical Examination (OSCE).
{"title":"The current situation of Radiology training in medical studies in Spain","authors":"F. Sendra Portero , D. Domínguez Pinos , M. Souto Bayarri","doi":"10.1016/j.rxeng.2023.07.003","DOIUrl":"https://doi.org/10.1016/j.rxeng.2023.07.003","url":null,"abstract":"<div><p>Radiology<span> is now an essential part of Clinical Medicine<span>, but undergraduate training does not reflect its importance in medical practice. In the current course, there are 46 medical schools in our country. According to the information published on the institutional websites, the study plans are very different in terms of the presence of Diagnostic Radiology and the organization of teaching. The estimated number of teaching hours in diagnostic radiology (mean ± standard deviation) is 61.3 ± 22.2 h (range from 26 h to 137 h). There is a great shortage of clinical university professors, and a generational change is essential. The current situation poses various challenges, including adapting to new teaching methods and technologies and promoting the presence of radiology in medical study plans, paying special attention to hospital practices, the Final Degree Project (FDP) and the Objective Structured Clinical Examination (OSCE).</span></span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138473857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.rxeng.2023.03.004
F. Conca , N. Rosso , R. López Grove , L. Savluk , J.P. Santino , M. Ulla
Objective
To review and describe the most characteristic radiological findings of the most frequent esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique.
Conclusion
Malignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly leiomyoma being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.
{"title":"Esophageal tumors: The keys to diagnosis by pneumo-computed tomography","authors":"F. Conca , N. Rosso , R. López Grove , L. Savluk , J.P. Santino , M. Ulla","doi":"10.1016/j.rxeng.2023.03.004","DOIUrl":"10.1016/j.rxeng.2023.03.004","url":null,"abstract":"<div><h3>Objective</h3><p><span>To review and describe the most characteristic radiological findings of the most frequent </span>esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique.</p></div><div><h3>Conclusion</h3><p><span>Malignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly </span>leiomyoma<span> being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.</span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135664992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Levels of evidence (LE) are established through a hierarchical classification of studies according to their design. At present, there are many heterogeneous LE classifications, and this hampers their applicability. Our study aims to identify which LE classification has the best interobserver concordance for radiology articles. For this purpose, an interobserver agreement analysis were performed on 105 original articles applying two NE scales (Oxford Center of Evidence Based Medicine (OCEBM) y National Health and Medical Research Council (NHMRC)). The inter-rater agreement of the LE assigned after reading the abstracts was good when using the OCEBM scale (K = 0.679), and somewhat lower with the NHMRC (K = 0.577 -moderate-). All differences were statistically significant (P < .000). So, in conclusion, of the two scales analysed (OCEBM and NHMRC), the OCEBM led to the strongest level of inter-rater agreement.
{"title":"Inter-observer agreement on levels of evidence in radiology articles","authors":"C. García-Villar , J.M. Plasencia-Martínez , M.T. Gutiérrez-Amares , J.M. García-Santos","doi":"10.1016/j.rxeng.2023.08.001","DOIUrl":"10.1016/j.rxeng.2023.08.001","url":null,"abstract":"<div><p><span>Levels of evidence (LE) are established through a hierarchical classification of studies according to their design. At present, there are many heterogeneous LE classifications, and this hampers their applicability. Our study aims to identify which LE classification has the best interobserver concordance for radiology<span> articles. For this purpose, an interobserver agreement analysis were performed on 105 original articles applying two NE scales (Oxford Center of Evidence Based Medicine<span> (OCEBM) y National Health and Medical Research Council (NHMRC)). The inter-rater agreement of the LE assigned after reading the abstracts was good when using the OCEBM scale (</span></span></span><em>K</em> = 0.679), and somewhat lower with the NHMRC (<em>K</em> = 0.577 -moderate-). All differences were statistically significant (<em>P</em> < .000). So, in conclusion, of the two scales analysed (OCEBM and NHMRC), the OCEBM led to the strongest level of inter-rater agreement.</p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136154004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.rxeng.2021.01.005
M. García Isidro, A. Ferreiro Pérez, M.S. Fernández López-Peláez, M. Moeinvaziri, P. Fernández García
Objective
To evaluate differences in measurements of the lateral recesses and foramina in degenerative lumbar segments on MR images in symptomatic patients obtained with the patient standing versus lying down and to analyze the relationship between possible differences and patients’ symptoms.
Material and methods
We studied 207 disc levels in 175 patients aged between 17 and 75 years (median: 47 years) with low back pain. All patients underwent MRI in the decubitus position with their legs extended, followed by MRI in the standing position. We calculated the difference in the measurements of the lateral recesses (in mm) and in the foramina (area in mm2 and smallest diameter in mm) obtained in the two positions. To eliminate the effects of possible errors in measurement, we selected cases in which the difference between the measurements obtained in the two positions was ≥10%; we used Student’s t-tests for paired samples to analyze the entire group and subgroups of patients according to age, sex, grade of disc degeneration, and postural predominance of symptoms.
Results
Overall, the measurements of the spaces were lower when patients were standing. For the lateral recesses, we observed differences ≥10% in 68 (33%) right recesses and in 65 (31.5%) left recesses; when patients were standing, decreases were much more common than increases (26% vs. 7%, respectively, on the right side and 24% vs. 7.5%, respectively, on the left side; p < 0.005). For the foramina, decreases in both the area and in the smallest diameter were also more common than increases when patients were standing: on the right side, areas decreased in 23% and increased in 4%, and smallest diameters decreased in 20% and increased 6%; on the left side, areas decreased in 24% and increased in 4%, and smallest diameters decreased in 17% and increased in 8% (p < 0.005). Considering the group of patients in whom the postural predominance of symptoms was known, we found significant differences in patients whose symptoms occurred predominantly or exclusively when standing, but not in the small group of patients whose symptoms occurred predominantly while lying. We found no differences between sexes in the changes in measurements of the recesses or foramina with standing. The differences between the measurements obtained in different positions were significant in patients aged >40 years, but not in younger groups of patients. Differences in relation to the grade of disc degeneration were significant only in intermediate grades (groups 3–6 in the Griffith classification system).
Conclusion
MRI obtained with patients standing can show decreases in the lateral recesses and foramina related to the predominance of symptoms while standing, especially in patients aged >40 years with Griffith disc degeneration grade 3–6, thus providing additional information in th
{"title":"Differences in MRI measurements of lateral recesses and foramina in degenerative lumbar segments in upright versus decubitus symptomatic patients","authors":"M. García Isidro, A. Ferreiro Pérez, M.S. Fernández López-Peláez, M. Moeinvaziri, P. Fernández García","doi":"10.1016/j.rxeng.2021.01.005","DOIUrl":"10.1016/j.rxeng.2021.01.005","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate differences in measurements of the lateral recesses and foramina in degenerative lumbar segments on MR images in symptomatic patients obtained with the patient standing versus lying down and to analyze the relationship between possible differences and patients’ symptoms.</p></div><div><h3>Material and methods</h3><p><span>We studied 207 disc levels in 175 patients aged between 17 and 75 years (median: 47 years) with low back pain. All patients underwent MRI in the decubitus position with their legs extended, followed by MRI in the standing position. We calculated the difference in the measurements of the lateral recesses (in mm) and in the foramina (area in mm</span><sup>2</sup><span> and smallest diameter in mm) obtained in the two positions. To eliminate the effects of possible errors in measurement, we selected cases in which the difference between the measurements obtained in the two positions was ≥10%; we used Student’s t-tests for paired samples to analyze the entire group and subgroups of patients according to age, sex, grade of disc degeneration, and postural predominance of symptoms.</span></p></div><div><h3>Results</h3><p>Overall, the measurements of the spaces were lower when patients were standing. For the lateral recesses, we observed differences ≥10% in 68 (33%) right recesses and in 65 (31.5%) left recesses; when patients were standing, decreases were much more common than increases (26% vs. 7%, respectively, on the right side and 24% vs. 7.5%, respectively, on the left side; p < 0.005). For the foramina, decreases in both the area and in the smallest diameter were also more common than increases when patients were standing: on the right side, areas decreased in 23% and increased in 4%, and smallest diameters decreased in 20% and increased 6%; on the left side, areas decreased in 24% and increased in 4%, and smallest diameters decreased in 17% and increased in 8% (p < 0.005). Considering the group of patients in whom the postural predominance of symptoms was known, we found significant differences in patients whose symptoms occurred predominantly or exclusively when standing, but not in the small group of patients whose symptoms occurred predominantly while lying. We found no differences between sexes in the changes in measurements of the recesses or foramina with standing. The differences between the measurements obtained in different positions were significant in patients aged >40 years, but not in younger groups of patients. Differences in relation to the grade of disc degeneration were significant only in intermediate grades (groups 3–6 in the Griffith classification system).</p></div><div><h3>Conclusion</h3><p>MRI obtained with patients standing can show decreases in the lateral recesses and foramina related to the predominance of symptoms while standing, especially in patients aged >40 years with Griffith disc degeneration grade 3–6, thus providing additional information in th","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.rxeng.2023.09.006
G. Serra del Carpio, M. Tapia Viñé, N. Torena, D. Bernabeu Taboada
Chronic expansive hematoma (CEH) is a rare lesion, characterized by the persistence and increase in size of an hematoma for a period greater than one month since the initial hemorrhage. The clinical importance of this pathology is due to the fact that it can simulate malignant soft tissue neoplasms, both clinically as a result of its progressive growth and radiologically for its findings in imaging studies. This article will review three cases of CEH in different scenarios, explaining the radiological findings in different imaging techniques such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and PET-CT.
{"title":"Chronic expanding hematoma","authors":"G. Serra del Carpio, M. Tapia Viñé, N. Torena, D. Bernabeu Taboada","doi":"10.1016/j.rxeng.2023.09.006","DOIUrl":"10.1016/j.rxeng.2023.09.006","url":null,"abstract":"<div><p>Chronic expansive hematoma (CEH) is a rare lesion, characterized by the persistence and increase in size of an hematoma for a period greater than one month since the initial hemorrhage. The clinical importance of this pathology is due to the fact that it can simulate malignant soft tissue neoplasms<span><span>, both clinically as a result of its progressive growth and radiologically for its findings in imaging studies. This article will review three cases of CEH in different scenarios, explaining the radiological findings in different </span>imaging techniques such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and PET-CT.</span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.rxeng.2022.12.008
G. Iglesias-Hidalgo , A. Lopez-Maseda , L. Zaldumbide-Dueñas , B. Canteli-Padilla
Granular cell tumors (GrCT) are histologically unique neoplasms that often manifest as painless solitary nodules located in the dermis or submucosal tissue. In this article we analyze the radiologic features of this type of tumor in five patients by magnetic resonance imaging (MRI), analyzing morphologic and signal characteristics. MR imaging findings were similar to other publications and we demonstrate low ADC values in our series.
{"title":"Granular cell tumor of soft tissues: MR findings","authors":"G. Iglesias-Hidalgo , A. Lopez-Maseda , L. Zaldumbide-Dueñas , B. Canteli-Padilla","doi":"10.1016/j.rxeng.2022.12.008","DOIUrl":"10.1016/j.rxeng.2022.12.008","url":null,"abstract":"<div><p>Granular cell tumors<span> (GrCT) are histologically unique neoplasms that often manifest as painless solitary nodules located in the dermis or submucosal tissue. In this article we analyze the radiologic features of this type of tumor in five patients by magnetic resonance imaging (MRI), analyzing morphologic and signal characteristics. MR imaging findings were similar to other publications and we demonstrate low ADC values in our series.</span></p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.rxeng.2020.09.008
A. Cardoso , J.N. Ferreira , R. Viegas , P. Amaro , P. Gamelas , R. Alonso , L. Pires
Introduction and objectives
This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology.
Material and methods
A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at arthroscopy, were correlated.
Results
Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53 ± 15° (23–90), a mean total opening angle of 80 ± 26° (30–135), a mean width of 10.3 ± 2.5 mm (6–19) and a mean depth of 4.1 ± 1.5 mm (1–8). Men had higher medial opening angle (60 vs 50°, p = 0.044) and wider grooves (11.9 vs 9.7 mm, p = 0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p < 0.001).
Conclusions
Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.
{"title":"Radiographic evaluation of the bicipital groove morphology does not predict intraarticular changes in the long head of biceps tendon","authors":"A. Cardoso , J.N. Ferreira , R. Viegas , P. Amaro , P. Gamelas , R. Alonso , L. Pires","doi":"10.1016/j.rxeng.2020.09.008","DOIUrl":"10.1016/j.rxeng.2020.09.008","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology.</p></div><div><h3>Material and methods</h3><p><span>A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at </span>arthroscopy, were correlated.</p></div><div><h3>Results</h3><p>Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53 ± 15° (23–90), a mean total opening angle of 80 ± 26° (30–135), a mean width of 10.3 ± 2.5 mm (6–19) and a mean depth of 4.1 ± 1.5 mm (1–8). Men had higher medial opening angle (60 vs 50°, p = 0.044) and wider grooves (11.9 vs 9.7 mm, p = 0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p < 0.001).</p></div><div><h3>Conclusions</h3><p>Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.</p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.rxeng.2023.09.005
J.J. Jover-Sánchez , L. Cristóbal-Velasco , E. Benza-Villarejo , A.A. Maldonado-Morillo
Intraneural ganglion cysts are very uncommon lesions, whose diagnosis has increased since the articular theory and the description of the MRI findings were established. We present a case report of a 59-year-old man with symptoms of tarsal tunnel syndrome. Foot and ankle MRI demonstrated the presence of an intraneural cystic lesion in the posterior tibial neve and its connection with the subtalar joint through an articular branch. The identification of the specific radiological signs like the «signet ring sign» allowed establishing an adequate preoperative diagnosis, differentiating it from an extraneural lesion and facilitating the articular disconnection of the nerve branch during surgery.
{"title":"Tarsal tunnel ganglion cyst: intraneural or extraneural site?","authors":"J.J. Jover-Sánchez , L. Cristóbal-Velasco , E. Benza-Villarejo , A.A. Maldonado-Morillo","doi":"10.1016/j.rxeng.2023.09.005","DOIUrl":"10.1016/j.rxeng.2023.09.005","url":null,"abstract":"<div><p><span>Intraneural ganglion cysts<span> are very uncommon lesions, whose diagnosis has increased since the articular theory and the description of the MRI findings were established. We present a case report of a 59-year-old man with symptoms of tarsal tunnel syndrome. Foot and ankle MRI demonstrated the presence of an intraneural cystic lesion in the posterior tibial neve and its connection with the </span></span>subtalar joint through an articular branch. The identification of the specific radiological signs like the «signet ring sign» allowed establishing an adequate preoperative diagnosis, differentiating it from an extraneural lesion and facilitating the articular disconnection of the nerve branch during surgery.</p></div>","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.rxeng.2023.02.004
J. Martel Villagrán , R.T. Martínez-Sánchez , E. Cebada-Chaparro , A.L. Bueno Horcajadas , E. Pérez-Fernández
Background
Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited.
Objectives
To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience.
Materials and methods
Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen’s kappa values and also using the McNemar test.
Results
340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen’s kappa-coefficient > 0’8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images.
Conclusions and significance
CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. T
{"title":"Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms","authors":"J. Martel Villagrán , R.T. Martínez-Sánchez , E. Cebada-Chaparro , A.L. Bueno Horcajadas , E. Pérez-Fernández","doi":"10.1016/j.rxeng.2023.02.004","DOIUrl":"10.1016/j.rxeng.2023.02.004","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. </span>Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in </span>lumbar spine evaluation of low back pain; however, availability of MRI is limited.</p></div><div><h3>Objectives</h3><p>To evaluate the diagnostic accuracy of computed tomography<span> (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience.</span></p></div><div><h3>Materials and methods</h3><p>Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen’s kappa values and also using the McNemar test.</p></div><div><h3>Results</h3><p>340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica<span>. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen’s kappa-coefficient > 0’8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images.</span></p></div><div><h3>Conclusions and significance</h3><p>CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. T","PeriodicalId":94185,"journal":{"name":"Radiologia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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