Jung-Ha Kim
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.
Authors
Rogier M. van Rijn
Maurits W. van Tulder
Bart W. Koes
Michiel R. de Boer
Abida Z. Ginai
Raymond W.G.J. Ostelo
Danielle Van Der Windt d.van.der.windt@keele.ac.uk
Arianne P. Verhagen
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.
Journal Article Type | Article |
---|---|
Acceptance Date | Jul 5, 2018 |
Publication Date | Aug 21, 2018 |
Journal | Chiropractic & Manual Therapies |
Print ISSN | 2045-709X |
Publisher | BioMed Central |
Peer Reviewed | Peer Reviewed |
Volume | 25 |
Article Number | 37 |
DOI | https://doi.org/10.1186/s12998-018-0207-x |
Keywords | Diagnostic accuracy, Systematic review, Lumbar disc herniation, Diagnostic imaging, Low back pain |
Publisher URL | http://doi.org/10.1186/s12998-018-0207-x |
Files
s12998-018-0207-x.pdf
(2.1 Mb)
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Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/
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