Imaging in the diagnostics of low back pain
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Z Kliniki Rehabilitacji Warszawskiego Uniwersytetu Medycznego Centrum Rehabilitacji w Konstancinie
Med Og. 2010;16(2):117-130
Diagnostic work-up of low back pain (LBP) is often characterized by overimaging. Abundance of information retrieved from images may sometimes be misleading and result in diagnostic pitfalls. The purpose of this review is to describe sensitivity and specificity of most often prescribed non-invasive imaging studies – plain radiography (PL) (static and dynamic), computed tomography (CT), magnetic resonance imaging (MRI) and bone scyntygraphy (BS). PL is sensitive and specific as a diagnostic tool in cases of advanced deformities related to ankylosing spondylitis, selected congenital and developmental malformations, but lack appropriate sensititvity in detecting early stages of tumor or infection. Due to low specificity PL is of limited value in diagnostics of spondylo-atrhrotic cause of LBP in older patients. Dynamic radiography is crucial in diagnostics of spinal instabilities. CT is useful in diagnostics of lumbar stenosis, as well as disc extrusion; however abnormalities may be detected in asymptomatic individuals. MRI is sensitive in diagnostics of tumor, infection, and disc pathologies; however, significant rate of asymptomatic disc deformities is reported. MRI is sensitive in the detection of tumors and foci of infection, and is characterised by high sensitivity with respect to intervertebral disc pathology, nevertheless a positive result is observed among a considerable percentage of people without LBP. BS is helpful in detection of regions of increased bone metabolism, but lacks cause specificity. Some authors recommend BS in children suspected of organic cause of LBP. Each referral for imaging examination in the case of LBP should be preceded by a thorough patient examination and the analysis of the role of the information anticipated in the diagnostictherapeutic process. The image description is not a diagnosis and does not seem to be useful and appropriate information for the patient.
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