title: Second-Opinion Subspecialty Consultations in Musculoskeletal Radiology.
abstract: OBJECTIVE
  The purpose of this article is to evaluate the significance of subspecialty second-opinion consultations for CT and MRI examinations in musculoskeletal (MSK) radiology.
  
  
  METHODS
  All 3165 MSK CT and MRI examinations referred to one academic institution for second-opinion consultation during a 24-month period were reviewed by three MSK-trained radiologists. Outside and inside reports were compared by two independent MSK radiology fellows using a previously published 5-point scale. Clinically important differences (categories 4 and 5) were defined as those likely to change patient management. Statistical comparisons of rates were performed using a chi-square test with Bonferroni corrections. Interobserver reliability was reported using linear weighted kappa statistics and the percentage of agreement.
  
  
  RESULTS
  Of all second-opinion examinations, 73.5% (2326/3165) had an outside report available for comparison and inclusion in this study. There were 610 of 2326 (26.2%) examinations with clinically important differences. The rate of clinically important discrepant readings was even higher in oncologic cases (36.3%; 331/911). When the final diagnosis was determined from pathology reports performed after internal interpretation, the second-opinion consultation was noted to be correct in 82.0% (334/407) of examinations with category 4 or 5 discrepancies. There was very good agreement (κ = 0.93) in scoring the discrepancies between second-opinion consultants.
  
  
  CONCLUSIONS
  The subspecialty second-opinion consultation was more accurate than outside reports in 82.0% of examinations when pathologic confirmation was made. A moderate rate (26.2%) of discrepant interpretations was noted between outside and inside MSK imaging examinations, especially in tumor cases (36.3%). Most discrepancies were in interpreting rather than detecting abnormalities.
authors.affiliation: 1 Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH.
authors.forename: Majid
authors.initials: M
authors.lastname: Chalian
authors.affiliation: 2 Russell H. Morgan Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Filippo
authors.initials: F
authors.lastname: Del Grande
authors.affiliation: 2 Russell H. Morgan Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Rashmi S
authors.initials: RS
authors.lastname: Thakkar
authors.affiliation: 2 Russell H. Morgan Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Sahar F
authors.initials: SF
authors.lastname: Jalali
authors.affiliation: 3 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Avneesh
authors.initials: A
authors.lastname: Chhabra
authors.affiliation: 4 Department of Radiology and Imaging, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E 70th St, 3E-012, New York, NY 10021.
authors.forename: John A
authors.initials: JA
authors.lastname: Carrino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging*; D011871:Radiology; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013038:Specialization; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: consultation; discrepancy; imaging; musculoskeletal; second opinion