title: Diagnostic accuracy of contemporary multidetector computed tomography (MDCT) for the detection of lumbar disc herniation.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of multidetector CT (MDCT) for detection of lumbar disc herniation with MRI as standard of reference.
  
  
  METHODS
  Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNR) of cerebrospinal fluid (CSF), annulus fibrosus (AF) and the spinal cord (SC) were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence and accuracy in the diagnosis of lumbar disc herniation using MRI as standard of reference. Inter-reader correlation was assessed with weighted κ.
  
  
  RESULTS
  Sensitivity, specificity, precision and accuracy of MDCT for disc protrusion were 98.8%, 96.5%, 97.1%, 97.8% (disc level), 97.7%, 92.9%, 98.6%, 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the discs. κ (>0.90) was excellent for both algorithms.
  
  
  CONCLUSIONS
  MDCT of the lumbar spine yields high diagnostic accuracy for detection of lumbar disc herniation. IR improves image quality so that the provided diagnostic accuracy is principally equivalent to MRI.
  
  
  CONCLUSIONS
  • MDCT is an accurate alternative to MRI in disc herniation diagnosis. • By IR enhanced image quality improves MDCT diagnostic confidence similar to MRI. • Advances in CT technology contribute to improved diagnostic performance in lumbar spine imaging.
authors.affiliation: Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany. Susan.Notohamiprodjo@med.lmu.de.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-1312-1245
authors.initials: S
authors.lastname: Notohamiprodjo
authors.affiliation: Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Stahl
authors.affiliation: Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Braunagel
authors.affiliation: Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: P M
authors.initials: PM
authors.lastname: Kazmierczak
authors.affiliation: Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: K M
authors.initials: KM
authors.lastname: Thierfelder
authors.affiliation: Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: K M
authors.initials: KM
authors.lastname: Treitl
authors.affiliation: Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Wirth
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Notohamiprodjo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000209:etiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D059629:Signal-To-Noise Ratio
keywords: Disc prolapse; Magnetic resonance imaging; Multidetector computed tomography; Nerve root compression; Sciatica