• Annemarie de Zoete, Raymond Ostelo, Dirk L Knol, Paul R Algra, Jan T Wilmink, Maurits W van Tulder, and MRI Study Group.
• *Department Health Sciences and EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Science, VU University Medical Center Amsterdam, Amsterdam, the Netherlands †Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, the Netherlands ‡Department of Health Sciences, Faculty of Earth & Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands §Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, the Netherlands ¶Medical Centre, Alkmaar, Alkmaar, the Netherlands ‖MRI Centre, Amsterdam, the Netherlands **Department of Health Science and EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Science, VU University Amsterdam, the Netherlands; and ††Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands. MRI group, they are working mainly in private practice.
• Spine. 2015 Jun 1;40(11):E653-60.

Study DesignA cross-sectional diagnostic accuracy study was conducted in 2 sessions.ObjectiveIt is important to know whether it is possible to accurately detect "specific findings" on lumbosacral magnetic resonance (MR) images and whether the results of different observers are comparable.Summary Of Background DataHealth care providers frequently use magnetic resonance imaging in the diagnostic process of patients with low back pain. The use of MR scans is increasing. This leads to an increase in costs and to an increase in risk of inaccurately labeling patients with an anatomical diagnosis that might not be the actual cause of symptoms.MethodsA set of 300 blinded MR images was read by medical radiologists, chiropractors, and chiropractic radiologists in 2 sessions. Each assessor read 100 scans in round 1 and 50 scans in round 2. The reference test was an expert panel.For all analyses, the magnetic resonance imaging findings were dichotomized into "specific findings" or "no specific findings." For the agreement, percentage agreement and κ values were calculated and for validity, sensitivity, and specificity. Sensitivity analysis was done for classifications A and B (prevalence of 31% and 57%, respectively).ResultsThe intraobserver κ values for chiropractors, chiropractic radiologists, and medical radiologists were 0.46, 0.49, and 0.69 for A and 0.55, 0.75, and 0.64 for B, respectively.The interobserver κ values were lowest for chiropractors (0.28 for A, 0.37 for B) and highest for chiropractic radiologists (0.50 for A, 0.49 for B).The sensitivities of the medical radiologists, chiropractors, and chiropractic radiologists were 0.62, 0.71, and 0.75 for A and 0.70, 0.74, 0.84 for B, respectively.The specificities of medical radiologists, chiropractic radiologists, and chiropractors were 0.82, 0.77, and 0.70 for A and 0.74, 0.52, and 0.61 for B, respectively.ConclusionAgreement and validity of MR image readings of chiropractors and chiropractic and medical radiologists is modest at best. This study supports recommendations in clinical guidelines against routine use of magnetic resonance imaging in patients with low back pain.Level Of Evidence3.

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