Sensitivity of magnetic resonance imaging in the diagnosis of mobile and nonmobile L4-L5 degenerative spondylolisthesis. 

 -  2015 
<br/><br/> BACKGROUND CONTEXT: Lumbar degenerative spondylolisthesis (LDS) is often diagnosed by conventional supine magnetic resonance imaging (MRI). Numerous studies have shown, however, that the degree of spondylolisthesis can be reduced or disappears when the patient is supine as compared with standing lateral and flexion-extension (SLFE) radiographs.  CONCLUSIONS: This study found that MRI had a sensitivity of 78% for detecting L4-L5 LDS compared with 98% for lateral standing films. We also identified facet effusion size as a marker to predict mobile LDS. These findings suggest that, particularly in the setting of facet effusions, the complete workup of patients in whom LDS is possible should include standing radiographs.Copyright © 2015 Elsevier Inc. All rights reserved.  METHODS: Lumbar degenerative spondylolisthesis was defined radiographically as a slip greater than 4.5 mm. Mobile LDS was defined as a difference of greater than 3% in slip percentage between lateral radiographs and sagittal MRIs. Additional measurements included L4-L5 facet effusion diameter on axial MRIs. Measurements were performed by two independent examiners. The kappa coefficient was used to assess the interobserver agreement.  PATIENT SAMPLE: Included patients diagnosed with L4-L5 LDS with both SLFE films and supine MRI.  PURPOSE: To compare the sensitivity of supine MRI with SLFE radiographs in patients with L4-L5 LDS.  RESULTS: Of 103 patients assessed, 68% were women and the average age was 66 years. Lumbar degenerative spondylolisthesis was seen on 101 (98%) lateral films and 80 (78%) MRIs. Average slip was 10.0 mm for lateral standing radiographs and 6.6 mm on MRI (p<.0001). Fifty (48%) patients were identified with mobile LDS. The positive predictive value of facet joint effusion for mobile LDS increased from 52% for effusions greater than 1 mm to 100% for effusions greater than 3.5 mm.  STUDY DESIGN: A retrospective imaging study. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1529-9430 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Intervertebral Disc Degeneration/di [Diagnosis]<br/>*Lumbosacral Region/pa [Pathology]<br/>*Magnetic Resonance Imaging<br/>*Spondylolisthesis/di [Diagnosis]<br/>Adult<br/>Aged<br/>Female<br/>Humans<br/>Intervertebral Disc Degeneration/ra [Radiography]<br/>Male<br/>Middle Aged<br/>Range of Motion, Articular<br/>Sensitivity and Specificity<br/>Spondylolisthesis/ra [Radiography]
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Orthopedic Surgery
<br/><br/><label>Index Terms--Function: </label><br/>Evaluation Studies<br/>Journal Article