RAPID MR VS XRAY: RANDOMIZED OUTCOME TRIAL FOR BACK PAIN

我们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 因为总成像时间仅约为2 分钟，快速MRI与平片相比具有成本竞争力。 因此 有可能在诊断中发挥重要作用， 下腰痛患者的后续治疗。 我们的目标是检查替代快速的 磁共振（MR）扫描平片X射线作为初始 下腰痛患者的影像学检查。 我们将测试 假设用快速MRI代替平片不仅 结果是更好的患者结果，但也将更具成本效益。 在腰痛患者的早期护理中使用快速MRI可能 通过以下方式使患者受益：1）提供更快速的明确诊断; 2） 避免了进一步的成像或转诊;以及3）使两个患者放心 医生说没有严重的疾病。 的风险 腰椎MRI上常见的偶然异常可能 导致不必要的诊断和治疗干预， 否则将无法进行，导致患者情况恶化 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 或诊断准确性。 为了验证我们的假设，我们将招募372名 要求进行X线平片检查的腰痛患者， 随机分配接受平片或快速MRI检查。 然后将对患者进行12个月的随访，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。 年度直接和间接费用总额估计数 在美国，腰痛的治疗费用接近500亿美元。 即使 快速MRI仅节省了直接医疗费用的1%， 换算成2.4亿美元/年 很可能使用 快速腰椎MRI将在未来几年内增加。 我们的目标 是评估取代现有的 腰椎X光片与这个有前途的新技术。 我们有一个 在快速磁共振成像广泛传播之前， 而随机试验是不可能的， 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.