Great note on an MRI report

[drrosenrosen]

Patient came to me recently with severe LLE pain, normal MRI (tiny disc bulge at L5), negative ultrasound for DVT, no musculoskeletal injury history. Her MRI report had this great addendum that I wish everyone would use, especially with the CARES act being in full effect and patients having full online access to all of their notes. Has anyone else seen notes like this added to MRI or other radiology reports? How can we encourage more of this from our radiology colleagues?

Comment: The following findings are so common in people without low back
pain that while we report their presence, they must be interpreted with
caution and in the context of the clinical situation. (Reference - Jarvik
et al. Spine 2001)

Findings: Prevalence in patients without low back pain: Disk degeneration
(decreased T2 signal, height loss, bulge) - 91%; disk T2 signal loss - 83%;
disk height loss 56%; disk bulge - 64%, disk protrusion - 32%, annular
fissure - 38%

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[callmeanesthesia]

Have seen once. Wish our local radiologists would. Maybe I should ask them.

 

[lobelsteve]

But what's causing her leg pain? At least it is not kidney or endometrial cancer.

 

[SSdoc33]

But what's causing her leg pain? At least it is not kidney or endometrial cancer.

she's got a big pelvic mass that the L-spine MRI missed.

call the local ambulance chaser!

seriously, at least check pulses. ive been burned a couple times by missing a vascular issue

 

[drrosenrosen]

Yeah no vascular issue that I can determine. Pulses adequate. US normal although they couldn't visualize calf veins due to body habitus. Also, pain has been present in the current distribution and severity for 2+ years. Stocking distribution numbness up to mid-thigh. She localizes pain to her lower back and radiating down the leg, but not in a dermatomal distribution. When I say tiny disc on the MRI, I mean, I wouldn't have even called it abnormal tiny. EMG was done yesterday, I'm waiting for the report but will be surprised if it is abnormal

 

[Baron Samedi]

Yeah no vascular issue that I can determine. Pulses adequate. US normal although they couldn't visualize calf veins due to body habitus. Also, pain has been present in the current distribution and severity for 2+ years. Stocking distribution numbness up to mid-thigh. She localizes pain to her lower back and radiating down the leg, but not in a dermatomal distribution. When I say tiny disc on the MRI, I mean, I wouldn't have even called it abnormal tiny. EMG was done yesterday, I'm waiting for the report but will be surprised if it is abnormal

Mononeuritis multiplex?

But yeah, a few of our radiologists include that addendum. Definitely a help.

 

[painfree23]

Patient came to me recently with severe LLE pain, normal MRI (tiny disc bulge at L5), negative ultrasound for DVT, no musculoskeletal injury history. Her MRI report had this great addendum that I wish everyone would use, especially with the CARES act being in full effect and patients having full online access to all of their notes. Has anyone else seen notes like this added to MRI or other radiology reports? How can we encourage more of this from our radiology colleagues?

Comment: The following findings are so common in people without low back
pain that while we report their presence, they must be interpreted with
caution and in the context of the clinical situation. (Reference - Jarvik
et al. Spine 2001)

Findings: Prevalence in patients without low back pain: Disk degeneration
(decreased T2 signal, height loss, bulge) - 91%; disk T2 signal loss - 83%;
disk height loss 56%; disk bulge - 64%, disk protrusion - 32%, annular
fissure - 38%

Does anyone have the article that was cited here?

 

[Ligament]

Patient came to me recently with severe LLE pain, normal MRI (tiny disc bulge at L5), negative ultrasound for DVT, no musculoskeletal injury history. Her MRI report had this great addendum that I wish everyone would use, especially with the CARES act being in full effect and patients having full online access to all of their notes. Has anyone else seen notes like this added to MRI or other radiology reports? How can we encourage more of this from our radiology colleagues?

Comment: The following findings are so common in people without low back
pain that while we report their presence, they must be interpreted with
caution and in the context of the clinical situation. (Reference - Jarvik
et al. Spine 2001)

Findings: Prevalence in patients without low back pain: Disk degeneration
(decreased T2 signal, height loss, bulge) - 91%; disk T2 signal loss - 83%;
disk height loss 56%; disk bulge - 64%, disk protrusion - 32%, annular
fissure - 38%

There are 1-2 large imaging chains in my area that always put this data in their reports.

 

[Laryngospasm]

I bet the PI attorneys don’t use people who put that in their report lol

 

[drusso]

Patient came to me recently with severe LLE pain, normal MRI (tiny disc bulge at L5), negative ultrasound for DVT, no musculoskeletal injury history. Her MRI report had this great addendum that I wish everyone would use, especially with the CARES act being in full effect and patients having full online access to all of their notes. Has anyone else seen notes like this added to MRI or other radiology reports? How can we encourage more of this from our radiology colleagues?

Comment: The following findings are so common in people without low back
pain that while we report their presence, they must be interpreted with
caution and in the context of the clinical situation. (Reference - Jarvik
et al. Spine 2001)

Findings: Prevalence in patients without low back pain: Disk degeneration
(decreased T2 signal, height loss, bulge) - 91%; disk T2 signal loss - 83%;
disk height loss 56%; disk bulge - 64%, disk protrusion - 32%, annular
fissure - 38%

What's the prevalence of those findings in people WITH low back pain? What's the point of getting an MRI in someone who doesn't have pain?

People with and without pain are fruits from different trees.

 

[thiswonthurtabit]

What's the prevalence of those findings in people WITH low back pain? What's the point of getting an MRI in someone who doesn't have pain?

People with and without pain are fruits from different trees.

I usually use that kind of information to help calm patients down. They say OMG my discs are all bulging and my spine is going to fall apart. I bring up the epidemiology for patient's without back pain and tell them my job is trying to figure out (based on history, exam, and possibly diagnostic injections) what the cause of their pain is because that while an MRI can show a ton of things, it doesn't mean that all of them are causing the problem (and likely have been present in their back for quite a while).

 

[Ducttape]

Patient came to me recently with severe LLE pain, normal MRI (tiny disc bulge at L5), negative ultrasound for DVT, no musculoskeletal injury history. Her MRI report had this great addendum that I wish everyone would use, especially with the CARES act being in full effect and patients having full online access to all of their notes. Has anyone else seen notes like this added to MRI or other radiology reports? How can we encourage more of this from our radiology colleagues?

Comment: The following findings are so common in people without low back
pain that while we report their presence, they must be interpreted with
caution and in the context of the clinical situation. (Reference - Jarvik
et al. Spine 2001)

Findings: Prevalence in patients without low back pain: Disk degeneration
(decreased T2 signal, height loss, bulge) - 91%; disk T2 signal loss - 83%;
disk height loss 56%; disk bulge - 64%, disk protrusion - 32%, annular
fissure - 38%

it is a canned report. I get similar on almost every lumbar MRI.

but the ones I get are age specific, which adds another layer of benefit. for example:

The following findings are so common in an asymptomatic patient that they must be interpreted with caution and in the context of a clinical situation. Among patient's in their 70?s who are asymptomatic, an MRI will find about:

93% have disc degeneration
94% have disc signal loss
76% have disc height loss
77% have a disc bulge
40% have a disc protrusion
27% have an annular fissure/tear
69% have facet degeneration
35% have spondylolisthesis

Reference: Brinjikji, W. Luetmer, P.H., Comstock B., Bresnahan B.W., Chen L.E., Deyo R.A., Halabi,S., Turner J.A., Avins A.L., James K., Wald J.T., Kallmes D.F., AJNR 2015 April; 36(4): 811-816.


for painfree23: Systematic literature review of imaging features of spinal degeneration in asymptomatic populations - PubMed

 

[Ducttape]

What's the prevalence of those findings in people WITH low back pain? What's the point of getting an MRI in someone who doesn't have pain?

People with and without pain are fruits from different trees.

but they are all still bananas

 

[SSdoc33]

i sort of like the radiologists staying out of the clinical side. i dont want their recommendations about consults, etc. if i dont follow their recs, then all of a sudden i have liability. anyway, the language about DDD is fine i guess. it just adds a lot of ink that may or may not be read anyway

 

[callmeanesthesia]

it is a canned report. I get similar on almost every lumbar MRI.

but the ones I get are age specific, which adds another layer of benefit. for example:

The following findings are so common in an asymptomatic patient that they must be interpreted with caution and in the context of a clinical situation. Among patient's in their 70?s who are asymptomatic, an MRI will find about:

93% have disc degeneration
94% have disc signal loss
76% have disc height loss
77% have a disc bulge
40% have a disc protrusion
27% have an annular fissure/tear
69% have facet degeneration
35% have spondylolisthesis

Reference: Brinjikji, W. Luetmer, P.H., Comstock B., Bresnahan B.W., Chen L.E., Deyo R.A., Halabi,S., Turner J.A., Avins A.L., James K., Wald J.T., Kallmes D.F., AJNR 2015 April; 36(4): 811-816.


for painfree23: Systematic literature review of imaging features of spinal degeneration in asymptomatic populations - PubMed

I have a big stack of printouts of Table 2, and I hand one to patients when they start talking about how they have 3 bulging discs. Many are actually appreciative.

 

[OneWord]

A note like this would be more helpful if the addendum incorporated the incidental finding stats for the patient’s age. Otherwise, rads loses credibility when the orths tells pt that no, two-level disc disease with severe central canal stenosis is not the norm for a 37 yo.