Diagnostic Accuracy of Contemporary Multidetector Computed Tomography for the Detection of Lumbar Disk Herniation

Introduction: To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) for detection of lumbar disk herniation with magnetic resonance imaging (MRI) as the standard of reference.

Methods: Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNRs) of cerebrospinal fluid, annulus fibrosus, and the spinal cord were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence, and accuracy in the diagnosis of lumbar disk herniation using MRI as the standard of reference. Interreader correlation was assessed with weighted κ.

Results: The percentages of sensitivity, specificity, precision, and accuracy of MDCT for disk protrusion were 98.8%, 96.5%, 97.1%, and 97.8% (disk level), and 97.7%, 92.9%, 98.6%, and 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the disks. The κ (> 0.90) was excellent for both algorithms.

Conclusion: MDCT of the lumbar spine yields high diagnostic accuracy for the detection of lumbar disk herniation. IR improves IQ so the provided diagnostic accuracy is principally equivalent to MRI.