Impact of Patient-Reported Symptom Information on Agreement in the MRI Diagnosis of Presumptive Lumbar Spine Pain Generator.

Background: Lumbar spine MRI is associated with a high prevalence of interpretive errors by radiologists. Treating physicians can obtain symptom information, correlate symptoms with MRI findings, and distinguish presumptive pain generators from incidental abnormalities. Objective: To capture symptom information using a patient questionnaire, review lumbar spine MRI examinations with and without symptom information, diagnose pain generators, and compare MRI diagnoses with clinical reference diagnoses. Methods: In this prospective study, 120 participants (median age 64, interquartile range 24.5 years; 70 men, 50 women) were recruited from patients referred for lumbar spine injections between February and June 2019. Participants completed electronic symptom questionnaires before injections. In 3 research arms, 6 radiologists diagnosed pain generators in 1) MRI studies reviewed with symptom information from questionnaires, 2) MRI studies reviewed without symptom information, and 3) MRI reports. Interreading agreement was analyzed. Blinded to questionnaire results, radiologists performing injections obtained patient histories, correlated symptoms with MRI, and diagnosed presumptive pain generators. These diagnoses served as clinical reference standards. Pain generators were categorized by type, level, and side and compared using kappa statistics. Diagnostic certainty was recorded using numeric values (0-100) and compared using Wilcoxon rank sum statistics. Results: When compared to the reference standard, agreement for type, level, and side of pain generator were almost perfect in MRI examinations reviewed with symptom information (κ=0.82-0.90), fair to moderate without symptom information (κ=0.28-.51) (all p < .001), and fair to moderate in MRI reports (κ=0.27-0.45) (all p < .001). Interreading agreement was almost perfect with symptom information (κ=0.82-0.90), but only moderate without symptom information (κ=0.42-0.56) (all p < .001). Diagnostic certainty levels were highest for radiologists performing injections (90.0 ± 9.9), and significantly higher for MRI review with symptom information versus without symptom information (85.0 ± 12.8 vs 63.4 ± 20.2, p <.001). Conclusion: In lumbar spine MRI, presumptive pain generators diagnosed using symptom information from electronic questionnaires showed almost perfect agreement with pain generators diagnosed using symptom information from direct patient interviews. Clinical impact: Patient-reported symptom information from a brief questionnaire can be correlated with MRI findings to distinguish presumptive pain generators from incidental abnormalities.