MRIs - The Positives and the False Positives
Tests – what are they good for?
In the realm of back pain tests, of MRIs that question must be examined. What are MRIs good for when the proportion of useful, influential MRI studies is so small? False positive MRI results upset those who receive these results. They inspire fear or caution where it’s not always warranted. MRIs like this blur the proper treatment plan. They spend a lot of money. Executive Chiropractic of Iowa carefully evaluates the need for MRI in the West Des Moines chiropractic treatment plan of West Des Moines back pain relief.
MEDICINE’S VIEW
Interpretations of MRI images by radiologists often differ. The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1) MRI imaging may produce misleading suspicion. When following the guidelines of the American College of Radiology, 93% of lumbar spine MRIs were appropriate. Of those, only 13% uncovered anything suspicious. Of the 36 MRIs that caused suspicion of cancer or infection, 81% were false-positive. 59% of the follow-up MRIs on those suspicious findings were false positives. (2) MRI imaging may misinform. For example, MRI shows that the presence of disc degeneration in asymptomatic persons – persons with no back pain – increases with age: 37% in 20 year olds and 96% in 80 year olds; disc bulges: 30% to 84%; disc protrusion: 29% to 43%; annular fissures 19% to 29%. These imaging findings suggest that these are signs of normal aging. They remind all doctors, remind chiropractors like yours at Executive Chiropractic of Iowa, to compare all such findings with patient symptoms. (1,3) Your West Des Moines chiropractor does this!
CHIROPRACTIC’S VIEW
Choosing Wisely guidelines for American chiropractors recommend not repeating spinal imaging and not getting spinal imaging for patients with acute low back pain in the first 6 weeks of back pain (except when “red flags” are present– issues that suggest something more sinister). (4) A review of the efficacy of the Canadian Choosing Wisely recommendations for imaging nonspecific spinal pain and symptoms reported that there is very low risk of missing a worrying cause of back pain. (5) The goal of guidelines is less imaging, fewer false positives. Executive Chiropractic of Iowa wants what’s best for our West Des Moines chiropractic care patients.
COX® TECHNIC’S VIEW
Chiropractors like yours at Executive Chiropractic of Iowa review all the symptoms, tests and images our West Des Moines chiropractic back pain patients [[present on|bring with them39] their first West Des Moines chiropractic visit. So many back pain patients present to Executive Chiropractic of Iowa with MRI images already done. Executive Chiropractic of Iowa will look at them but will depend more on clinical exam findings and correlate them to what the MRI reveals. A rule of thumb with the Cox Technic System of Back Pain Relief is to work toward 50% decrease of back pain in the first month of care before arranging additional imaging or testing or referring for surgical consultation. (6)
CONTACT Executive Chiropractic of Iowa
Listen to this PODCAST with Dr. Dan Clark on the Back Doctor’s Podcast with Dr. Michael Johnson as he explains the role of imaging for back pain in the scheme of treatment for pain relief.
Schedule your West Des Moines chiropractic appointment with Executive Chiropractic of Iowa today. Let us discover together the best path to West Des Moines back pain relief – with or without MRI imaging!
