The Limited Protocol MRI in Diagnosis of Lumbar Disc Herniation
Orasa Chawalparit MD*, Anchalee Churojana MD*, Pipat Chiewvit MD*, Surin Thanapipatsir MD**, Visit Vamvanij MD**, Panida Charnchaowanish MD*,
Affiliation : * Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University ** Department of Orthopedics, Faculty of Medicine Siriraj Hospital, Mahidol University
Objective : To assess agreement in detection of lumbar disc herniation (LDH) between limited and full protocol
MRI.
Materials and Methods : 123 patients who requested lumbar MRI for diagnosis of disc herniation were assessed.
The full protocol MRI composed of sagittal T1-wi, sagittal T2-wi and axial T2-wi was performed on each
patient. The sagittal T2-wi was selected as the limited protocol MRI. The limited and full protocols MRI of each
patient were separately interpreted by three neuroradiologists to assess disc herniation and nerve root
compression. The consensus results of limited and full protocol were compared. The diagnostic performance of
each protocol was analyzed using surgery as the gold standard.
Results : There were 62 females and 61 males enrolled into the study between the age of 21-60 years old (means
= 42.91 years). The duration of pain was 1-204 months (mean = 31.20 months). The degree of severity was
mild in 23.58%, moderate 45.52% and severe 30.89% of cases. Thirty-three cases were operatedon. For
detection of LDH, the limited protocol gave the same interpretation results as the full protocol ((cid:31) = 1.04,
95%CI = 0.94, 1.14 with accepted range of 0.95-1.05). In nerve root compression, the limited protocol was not
accurate as the full protocol ((cid:31) = 0.75, 95%CI = 0.87, 0.63). The sensitivity, specificity, accuracy, PPV, NPV,
and LR+ in the surgical group of limited protocol in diagnosis of LDH were 82.61%, 80%, 81.82%, 90.48%,
60.67%, 4.13 and in nerve root compression were 54.84%, 100%, 57.58%, 100%, 12.5% respectively. The
same statistics of full protocol MRI in diagnosis of LDH were 82.61%, 70.80%, 78.79%, 86.36%, 63.64%,
2.75 and of nerve root compression were 80.65%, 100%, 81.82%, 100%, 25% respectively. The sensitivity
and specificity in diagnosis of LDH were not different in both protocols but the sensitivity of nerve root
compression was statistically significant different (p < 0.013, 95%CI = -0.33, -0.25).
Conclusion : The authors concluded that limited protocol MRI may replace full protocol MRI in diagnosis of
LDH but not in nerve root compression.
Keywords : Low back pain, Magnetic resonance imaging, MRI, Lumbar disc herniation, Diagnosis
