Reliability and validity of subjective radiologist reporting of temporal changes in lumbar spine MRI findings.

BACKGROUND The importance of lumbar findings on magnetic resonance imaging (MRI) remains controversial. Temporal changes in lumbar MRI findings over time may provide important insights into the causes of low back pain. However, the reliability and validity of temporal changes is unknown. OBJECTIVE The purpose of this study was to 1) Investigate the inter-rater reliability of subjective radiologist reporting of temporal changes in lumbar spine MRI findings, and 2) determine how commonly temporal changes are reported when two scans are conducted 30 minutes apart (considered false positives). DESIGN Cross-sectional study. SETTING Radiology clinic. PARTICIPANTS 40 volunteers (mean age 40; 53% female) with current (n = 31) or previous (n = 9) low back pain underwent an initial lumbar MRI scan on a single 3 T scanner. Participants then lay on a bed for 30 minutes before undergoing an identical MRI. In addition, we purposely selected 5 participants from a previous study with repeat lumbar MRI scans where temporal changes were reported in at least one MRI finding (1-12 weeks after initial scan) and another 5 participants where no temporal change was reported. The 10 participants were included in analyses for aim 1 only. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Two blinded radiologists reported on temporal changes between the baseline and repeat scan for 12 different MRI findings (eg, disc herniation, annular fissure) at 5 levels. RESULTS The inter-rater reliability of subjective reporting of temporal changes was poor for all MRI findings based on Kappa values (≤ 0.24), but agreement was relatively high (≥ 90.8%). This is explained by the low prevalence of temporal changes as demonstrated by high values for Prevalence and Bias Adjusted Kappa (≥ 0.82). "False positive" temporal changes were reported by at least one radiologist for most MRI findings, but the rate was generally low. CONCLUSIONS Caution is required when interpreting temporal changes in lumbar MRI findings due to low reliability and some false positive reporting. This article is protected by copyright. All rights reserved.