MRI evaluation of the lumbar spine: a survey-based assessment of protocols and practice patterns used by musculoskeletal radiologists in the United States.

Abstract

Given the lack of consensus in lumbar spine MRI protocols, this study sought to characterize current practice patterns among musculoskeletal radiologists in the United States. An anonymous 13-item web-based survey covering protocol sharing, sequence selection, and advanced techniques was distributed to members of the Society of Skeletal Radiology and the Society of Academic Bone Radiologists from 12/2022 to 2/2023. Frequency counts and proportions were calculated from the collected responses. One hundred ninety-three musculoskeletal radiologists completed the survey; 171/193 (88.6%) actively interpret lumbar spine MRI, and 137/193 (71%) reported using a shared protocol with neuroradiologists. The most common protocol combines sagittal T1-weighted, T2-weighted, and short tau inversion recovery (STIR) sequences (150/193 (77.7%)). For axial imaging, respondents use a T1- and T2-weighted pair (102/193, 54.5%) or T2-weighted imaging alone (64/193, 34.2%). Fat suppression is applied to postcontrast T1-weighted images more frequently in the sagittal plane (149/193 (77.2%)) than axially (102/193 (52.8%)), with use dictated by indication or subspecialty preference (less frequent in neuroradiologists' protocols). Specialized sequences are uncommon (3D imaging (19/193, 9.8%), diffusion-weighted imaging (4/193, 2.1%), chemical-shift imaging (17/193, 9.7%)) and are typically reserved for specific indications. Practices in the United States converge on a core lumbar spine MRI protocol-sagittal T1-weighted, T2-weighted, and STIR sequences with axial T2-weighted imaging-yet diverge in optional elements. Musculoskeletal radiologists use fat-suppressed imaging more than neuroradiologists, while specialized techniques are deployed selectively. Recognizing these variations could potentially enhance interpretive consistency, standardize protocols for research, and support rapid protocol development.