Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; A systematic review

Jung-Ha Kim, Rogier M. van Rijn, Maurits W. van Tulder, Bart W. Koes, Michiel R. de Boer, Abida Z. Ginai, Raymond W. G. J. Ostelo, Danielle A. M. W. van der Windt, Arianne P. Verhagen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Main text: We aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients. For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach. We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7%. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3% (95%CI 72.3-87.7%) and specificity: 77.1% (95%CI 61.9-87.5%)). The quality of evidence was moderate to very low. Conclusions: The diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today's more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.
Original languageEnglish
Article number37
JournalChiropractic and Manual Therapies
Volume26
Issue number1
DOIs
Publication statusPublished - 2018

Cite this

Kim, Jung-Ha ; van Rijn, Rogier M. ; van Tulder, Maurits W. ; Koes, Bart W. ; de Boer, Michiel R. ; Ginai, Abida Z. ; Ostelo, Raymond W. G. J. ; van der Windt, Danielle A. M. W. ; Verhagen, Arianne P. / Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; A systematic review. In: Chiropractic and Manual Therapies. 2018 ; Vol. 26, No. 1.
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title = "Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; A systematic review",
abstract = "Main text: We aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients. For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach. We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7{\%}. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3{\%} (95{\%}CI 72.3-87.7{\%}) and specificity: 77.1{\%} (95{\%}CI 61.9-87.5{\%})). The quality of evidence was moderate to very low. Conclusions: The diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today's more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.",
author = "Jung-Ha Kim and {van Rijn}, {Rogier M.} and {van Tulder}, {Maurits W.} and Koes, {Bart W.} and {de Boer}, {Michiel R.} and Ginai, {Abida Z.} and Ostelo, {Raymond W. G. J.} and {van der Windt}, {Danielle A. M. W.} and Verhagen, {Arianne P.}",
year = "2018",
doi = "10.1186/s12998-018-0207-x",
language = "English",
volume = "26",
journal = "Chiropractic and Manual Therapies",
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Kim, J-H, van Rijn, RM, van Tulder, MW, Koes, BW, de Boer, MR, Ginai, AZ, Ostelo, RWGJ, van der Windt, DAMW & Verhagen, AP 2018, 'Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; A systematic review' Chiropractic and Manual Therapies, vol. 26, no. 1, 37. https://doi.org/10.1186/s12998-018-0207-x

Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; A systematic review. / Kim, Jung-Ha; van Rijn, Rogier M.; van Tulder, Maurits W.; Koes, Bart W.; de Boer, Michiel R.; Ginai, Abida Z.; Ostelo, Raymond W. G. J.; van der Windt, Danielle A. M. W.; Verhagen, Arianne P.

In: Chiropractic and Manual Therapies, Vol. 26, No. 1, 37, 2018.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; A systematic review

AU - Kim, Jung-Ha

AU - van Rijn, Rogier M.

AU - van Tulder, Maurits W.

AU - Koes, Bart W.

AU - de Boer, Michiel R.

AU - Ginai, Abida Z.

AU - Ostelo, Raymond W. G. J.

AU - van der Windt, Danielle A. M. W.

AU - Verhagen, Arianne P.

PY - 2018

Y1 - 2018

N2 - Main text: We aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients. For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach. We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7%. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3% (95%CI 72.3-87.7%) and specificity: 77.1% (95%CI 61.9-87.5%)). The quality of evidence was moderate to very low. Conclusions: The diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today's more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.

AB - Main text: We aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients. For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach. We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7%. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3% (95%CI 72.3-87.7%) and specificity: 77.1% (95%CI 61.9-87.5%)). The quality of evidence was moderate to very low. Conclusions: The diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today's more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.

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