Background Distinguishing lumbar pain generators from incidental findings at MRI can be difficult. Dictated reports may become lists of findings that cannot be ranked in order of diagnostic importance. Purpose To determine whether patient-reported symptom information can improve the interpretation of lumbar spine MRI by using the spine specialist as the reference standard. Materials and Methods This prospective, single-center, multireader study analyzed 240 participants who completed pre-MRI symptom questionnaires between May 2022 and February 2023. At the time of clinical MRI reporting, radiologists recorded pain generators in consecutive participants, creating two study groups by alternating interpretations with versus without symptom questionnaire results (SQR). Diagnostic certainty was recorded using a numeric scale of 0 to 100. Types, levels, and sides of pain generators were compared with reference diagnoses by calculating Cohen κ values with 95% CIs. Participant characteristics and diagnostic certainties were compared using the Wilcoxon rank sum, Pearson χ2, or Kruskal-Wallis test. Interrater agreement was analyzed. Results There was no difference in age (P = .69) or sex (P = .60) between participants using SQR (n = 120; mean age, 61.0 years; 62 female) and not using SQR (n = 120; mean age, 62.5 years; 67 female). When radiologists were compared with specialists, agreements on pain generators were almost perfect for interpretations using SQR (type: κ = 0.82 [95% CI: 0.74,0.89]; level: κ = 0.88 [95% CI: 0.80, 0.95]; side: κ = 0.84 [95% CI: 0.75, 0.92]), but only fair to moderate for interpretations not using SQR (type: κ = 0.26 [95% CI: 0.15, 0.36]; level: κ = 0.51 [95% CI: 0.39, 0.63]; side: κ = 0.30 [95% CI: 0.18, 0.42]) (all P < .001). Diagnostic certainty was higher for MRI interpretations using SQR (mean, 80.4 ± 14.9 [SD]) than MRI interpretations not using SQR (60.5 ± 17.7) (P < .001). Interrater agreements were substantial (κ = 0.65-0.78) for MRI interpretations using SQR but only fair to moderate (κ = 0.24-0.49) for MRI interpretations not using SQR (all P < .001). Conclusion Patient-reported symptom information enabled radiologists to achieve nearly perfect diagnostic agreement with clinical experts. © RSNA, 2024 See also the editorial by Isikbay and Shah in this issue.

中文翻译：

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患者报告的症状信息对腰椎 MRI 解释的影响。


背景 区分腰痛的来源和 MRI 的偶然发现可能很困难。听写的报告可能会成为无法按诊断重要性顺序排序的结果列表。目的 使用脊柱专家作为参考标准，确定患者报告的症状信息是否可以改善对腰椎 MRI 的解释。材料和方法 这项前瞻性、单中心、多读者研究分析了 2022 年 5 月至 2023 年 2 月期间完成 MRI 前症状问卷的 240 名参与者。在临床 MRI 报告时，放射科医生记录了连续参与者的疼痛发生器，通过交替解释有和没有症状问卷结果 （SQR） 来创建两个研究组。使用 0 到 100 的数字量表记录诊断确定性。通过计算具有 95% CI 的 Cohen κ 值，将疼痛发生器的类型、水平和侧面与参考诊断进行比较。使用 Wilcoxon 秩和、Pearson χ2 或 Kruskal-Wallis 检验比较参与者特征和诊断质量。分析评分者间一致性。结果 使用 SQR （n = 120;平均年龄 61.0 岁;62 名女性） 和不使用 SQR （n = 120;平均年龄 62.5 岁;67 名女性） 的参与者在年龄 （P = .69） 或性别 （P = .60） 方面没有差异。当放射科医生与专家进行比较时，关于疼痛发生器的一致性几乎完美地适合使用 SQR 进行解释（类型：κ = 0.82 [95% CI：0.74,0.89];水平：κ = 0.88 [95% CI：0.80,0.95];侧面：κ = 0.84 [95% CI：0.75,0.92]），但对于不使用 SQR 的解释，仅一般至中等（类型：κ = 0.26 [95% CI：0.15,0.36];水平：κ = 0.51 [95% CI： 0.39, 0.63];侧：κ = 0.30 [95% CI： 0.18， 0.42]） （均 P < .001）。 使用 SQR 的 MRI 解释的诊断确定性 （平均值，80.4 ± 14.9 [SD]）高于不使用 SQR 的 MRI 解释 （60.5 ± 17.7） （P < .001）。使用 SQR 的 MRI 解释的评分者间一致性很高 （κ = 0.65-0.78），但对于不使用 SQR 的 MRI 解释，评分者间一致性仅为一般至中等 （κ = 0.24-0.49） （均 P < .001）。结论 患者报告的症状信息使放射科医生能够与临床专家达成近乎完美的诊断一致性。© RSNA，2024 年另见 Isikbay 和 Shah 在本期的社论。