RAPID MR VS XRAY: RANDOMIZED OUTCOME TRIAL FOR BACK PAIN

我们已经开发了一种快速磁共振成像(MRI)研究 几乎所有的临床MRI都可以进行腰椎检查 扫描仪。因为总成像时间只有大约2 与普通胶片相比，快速核磁共振成像的成本更具竞争力。因此，它 有可能在诊断和诊断中发挥重要作用 下腰痛患者的后续治疗。 我们的目标是研究用快速的 以平片x光为初始的磁共振(MR)扫描 下腰痛患者的影像检查。我们将测试 假设用快速核磁共振成像代替普通胶片不仅 带来更好的患者结果，但也将更具成本效益。 在下腰痛患者的早期护理中使用快速核磁共振可能会 患者从以下方面受益：1)提供更快的明确诊断；2) 避免了进一步的成像或转诊；以及3)让两位患者放心 和医生说，没有严重的疾病。存在这样一种风险： 腰椎MRI上常见的偶发异常可能 导致不必要的诊断和治疗干预 否则不会进行手术，导致两个更糟糕的患者 结果和更高的成本。评估这些相互竞争的可能性 需要测量实际的患者结果，而不仅仅是图像质量 或者诊断的准确性。为了检验我们的假设，我们将招募372人 有下腰痛的患者需要做普通的x光检查， 并随机分配他们接受普通胶片或快速核磁共振成像。 然后将对患者进行为期12个月的跟踪调查，以确定临床 结果和患者满意度，对诊断和治疗的影响 决策和资源利用。 可归因于以下方面的年度直接和间接费用总额估计数 在美国，腰部疼痛接近500亿美元。即使是在 快速核磁共振只节省了1%的直接医疗成本，这 换算成2.4亿美元/年。很可能是使用 在接下来的几年里，快速腰椎核磁共振成像将会增加。我们的目标 是评估替换的实际和现实的后果 使用这项前景看好的新技术进行腰椎X光检查。我们有一个 在快速MRI广泛传播之前的机会之窗 由于双方的期望，随机试验变得不可能 病人和医生。

We have developed a rapid magnetic resonance imaging (MRI) study of the lumbar spine that can be performed using nearly all clinical MRI scanners. Because the total imaging time is only approximately 2 minutes, the rapid MRI is cost competitive with plain films. Thus, it has the potential for playing a major role in the diagnosis and subsequent treatment of patients with low back pain. Our goal is to examine the consequences of substituting the rapid magnetic resonance (MR) scan for plain film x-rays as the initial imaging examination in patients with low back pain. We will test the hypothesis that substituting a rapid MRI for plain films will not only result in better patient outcomes, but will also be more cost-effective. Using a rapid MRI early in the care of patients with low back pain might benefit patients by: 1) providing a more rapid definitive diagnosis; 2) obviating further imaging or referral; and 3) reassuring both patient and physician that there is no serious disease. There is a risk that the incidental abnormalities commonly seen on lumbar spine MRI might lead to unnecessary diagnostic and therapeutic interventions that otherwise would not have been performed, resulting in both worse patient outcomes and higher costs. Evaluating these competing possibilities requires measuring actual patient outcomes, and not merely image quality or diagnostic accuracy. To test our hypothesis, we will recruit 372 patients with low back pain for whom plain x-rays have been requested, and randomly assign them to receive either plain films or the rapid MRI. Patients will then be followed for 12 months to ascertain clinical outcome and patient satisfaction, impact on diagnostic and therapeutic decision-making, and utilization of resources. Estimates of the total annual direct and indirect costs attributable to low back pain in the U.S. approach 50 billion dollars. Even if the rapid MRI saves only 1 percent of only the direct medical costs, this translates into 240 million dollars/year. It is likely that use of the rapid lumbar MRI will increase over the next several years. Our goal is to evaluate the practical and realistic consequences of replacing lumbar spine x-rays with this promising new technology. We have a window of opportunity before the rapid MRI becomes widely disseminated and a randomized trial is made impossible by the expectations of both patients and physicians.