Evaluation of the Precision of Lumbosacral Radiography in Detecting Lumbar Herniated Nucleus Pulposus Compared to MRI 3 Tesla as the Gold Standard
DOI:
https://doi.org/10.24252/alami.v10i2.65534Keywords:
Lumbosacral Radiography, Herniated Nucleus Pulposus, Magnetic Resonance Imaging, Diagnostic AccuracyAbstract
Background: Low back pain is one of the leading causes of disability worldwide, and herniated nucleus pulposus (HNP) is among its most common causes. Magnetic resonance imaging (MRI) is the diagnostic gold standard, while lumbosacral radiography is still widely used as an initial imaging modality despite limited local evidence on its diagnostic performance.
Objective: To evaluate the diagnostic accuracy of lumbosacral radiography in detecting HNP compared with 3 Tesla MRI as the reference standard.
Methods: This analytic observational study used a cross-sectional design with secondary data from 62 subjects with clinical suspicion of HNP who underwent both lumbosacral radiography and 3 Tesla MRI at RSUP Dr. Wahidin Sudirohusodo Makassar during January-December 2024, selected by consecutive sampling. Sensitivity, specificity, and Cohen's Kappa agreement were calculated using a 2×2 cross-tabulation.
Results: Of 62 subjects, 17 (27.4%) had positive and 45 (72.6%) had negative lumbosacral radiography findings, while 55 (88.7%) had positive and 7 (11.3%) had negative MRI findings. Lumbosacral radiography showed a sensitivity of 25.45% (95% CI: 15.8-38.3%) and specificity of 57.14% (95% CI: 25.1-84.2%), with a Cohen's Kappa of −0.052 (p = 0.331), indicating poor agreement with MRI.
Conclusion: Lumbosacral radiography has limited diagnostic accuracy for detecting HNP and shows poor agreement with 3 Tesla MRI. It remains useful as an initial screening tool but should not be used as the sole basis for diagnosing HNP; MRI should be prioritized in patients with strong clinical suspicion.
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