title: Limited magnetic resonance imaging of the lumbar spine has high sensitivity for detection of acute fractures, infection, and malignancy.
abstract: OBJECTIVE
  The objective of this study is to determine how a limited protocol MR examination compares to a full conventional MR examination for the detection of non-degenerative pathology such as acute fracture, infection, and malignancy.
  
  
  METHODS
  A sample of 349 non-contrast MR exams was selected retrospectively containing a 3:1:1:1 distribution of negative/degenerative change only, acute fracture, infection, and malignancy. This resulted in an even distribution of pathology and non-pathology. A limited protocol MR exam was simulated by extracting T1-weighted sagittal and T2-weighted fat-saturated (or STIR) sagittal sequences from each exam and submitting them for blinded review by two experienced musculoskeletal radiologists. The exams were evaluated for the presence or absence of non-degenerative pathology. Interpretation of the limited exam was compared to the original report of the full examination. If either reader disagreed with the original report, the case was submitted for an unblinded adjudication process with the participation of a third musculoskeletal radiologist to establish a consensus diagnosis.
  
  
  RESULTS
  There were five false negatives for a sensitivity of 96.9 % for the limited protocol MR exam. Infection in the psoas, paraspinal muscles, and sacroiliac joint, as well as acute fractures in transverse processes and sacrum were missed by one or more readers. No cases of malignancy were missed. Overall diagnostic accuracy was 96.0 % (335/349).
  
  
  CONCLUSIONS
  MR imaging of the lumbar spine limited to sagittal T1-weighted and sagittal T2 fat-saturated (or STIR) sequences has high sensitivity for the detection of acute fracture, infection, or malignancy compared to a conventional MR examination.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. bwang9@partners.org.
authors.forename: Benjamin
authors.identifier: http://orcid.org/0000-0002-7533-6436
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Florian J
authors.initials: FJ
authors.lastname: Fintelmann
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Kamath
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Kattapuram
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007239:Infections / Q000000981:diagnostic imaging*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012447:Sacrum; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Health care costs; Health care value; Limited protocol lumbar spine MRI; Low back pain; Lumbar spine MRI