title: Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica.
abstract: BACKGROUND
  Gadolinium-enhanced magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar disc surgery. However, correlation between enhancement and clinical findings is debated, and limited data are available regarding the reliability of enhancement findings.
  
  
  OBJECTIVE
  To evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica.
  
  
  METHODS
  Prospective observational evaluation of patients who were enrolled in a randomized trial with 1-year follow-up.
  
  
  METHODS
  Patients with 6- to 12-week sciatica, who participated in a multicentre randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after 1 year.
  
  
  METHODS
  Patients were assessed by means of the Roland Disability Questionnaire (RDQ) for sciatica, visual analog scale (VAS) for leg pain, and patient-reported perceived recovery at 1 year. Kappa coefficients were used to assess interobserver reliability.
  
  
  METHODS
  In total, 204 patients underwent Gd-MRI at baseline and after 1 year. Magnetic resonance imaging findings were correlated to the outcome measures using the Mann-Whitney U test for continuous data and Fisher exact tests for categorical data.
  
  
  RESULTS
  Poor-to-moderate agreement was observed regarding Gd enhancement of the herniated disc and compressed nerve root (kappa<0.41), which was in contrast with excellent interobserver agreement of the disc level of the herniated disc and compressed nerve root (kappa>0.95). Of the 59 patients with an enhancing herniated disc at 1 year, 86% reported recovery compared with 100% of the 12 patients with nonenhancing herniated discs (p=.34). Of the 12 patients with enhancement of the most affected nerve root at 1 year, 83% reported recovery compared with 85% of the 192 patients with no enhancement (p=.69). Patients with and without enhancing herniated discs or nerve roots at 1 year reported comparable outcomes on RDQ and VAS-leg pain.
  
  
  CONCLUSIONS
  Reliability of Gd-MRI findings was poor-to-moderate and no correlation was observed between enhancement and clinical findings at 1-year follow-up.
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands. Electronic address: A.el_barzouhi@lumc.nl.
authors.forename: Abdelilah
authors.initials: A
authors.lastname: el Barzouhi
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Carmen L A M
authors.initials: CL
authors.lastname: Vleggeert-Lankamp
authors.affiliation: Department of Radiology, Medical Center Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Lycklama à Nijeholt
authors.affiliation: Department of Radiology, Medical Center Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
authors.forename: Bas F
authors.initials: BF
authors.lastname: Van der Kallen
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Wilbert B
authors.initials: WB
authors.lastname: van den Hout
authors.affiliation: Department of General Practice, Erasmus Medical Center, University Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands; Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
mesh_terms: D000328:Adult; D003287:Contrast Media; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D007403:Intervertebral Disc; D007405:Intervertebral Disc Displacement; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010147:Pain Measurement; D011446:Prospective Studies; D015203:Reproducibility of Results; D012585:Sciatica / Q000473:pathology* / Q000601:surgery
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Clinical outcome; Conservative treatment; Disc herniation; Follow-up; Gadolinium-enhanced MRI findings; Sciatica; Surgery