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 constructive, influential MRI studies is so small? False positive MRI results trouble those who get such results. They inspire fear or caution where it is not always needed. MRIs like this confuse the proper treatment plan. They spend a lot of money. Dr. Hoang's Chiropractic Clinic carefully weighs the necessity of MRI in the Montreal chiropractic treatment plan of Montreal back pain relief.

MEDICINE’S VIEW

MRI interpretations by radiologists often differ.  The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1) MRI imaging may cause false suspicion. When following the guidelines of the American College of Radiology, 93% of lumbar spine MRIs were appropriate. Of those, only 13% found anything that needed to be addressed. Of the 36 MRIs that roused 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 – grows 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 Dr. Hoang's Chiropractic Clinic, to correlate all such findings with patient symptoms. (1,3) Your Montreal chiropractor does this!

CHIROPRACTIC’S VIEW

Choosing Wisely guidelines for American chiropractors recommend not repeating spinal imaging and not obtaining 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 indicate something more worrisome). (4) A review of the success of the Canadian Choosing Wisely recommendations for imaging nonspecific spinal pain and symptoms reported that there is very low risk of missing a serious cause of back pain. (5) The goal of guidelines is less imaging, fewer false positives.  Dr. Hoang's Chiropractic Clinic wants what’s best for our Montreal chiropractic care patients.

COX® TECHNIC’S VIEW

Chiropractors like yours at Dr. Hoang's Chiropractic Clinic review all the symptoms, tests and images our Montreal chiropractic back pain patients [[present on|bring with them39] their first Montreal chiropractic visit. So many back pain patients present to Dr. Hoang's Chiropractic Clinic with MRI images already done. Dr. Hoang's Chiropractic Clinic will look at them but will rely more on clinical exam findings and link 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 Dr. Hoang's Chiropractic Clinic

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 program of treatment for pain relief.

Schedule your Montreal chiropractic appointment with Dr. Hoang's Chiropractic Clinic today. Let us discover together the best path to Montreal back pain relief – with or without MRI imaging!