MRIs - The Positives and the False Positives

May 22, 2018

Tests – what are they good for?

When it comes to back pain tests, of MRIs that question must be questioned. What are MRIs good for when the percentage of constructive, influential MRI studies is so small? False positive MRI results distress those who get these results. They arouse fear or caution where it’s not always needed. MRIs like this blur the proper treatment plan. They cost quite a bit. Dr. Butwell carefully evaluates the necessity of MRI in the Georgetown chiropractic treatment plan of Georgetown back pain relief.


MRI interpretations by radiologists often vary.  The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1) MRI imaging may cause misleading suspicion. When following the guidelines of the American College of Radiology, 93% of lumbar spine MRIs were appropriate. Of those, only 13% revealed anything that needed to be addressed. Of the 36 MRIs that roused suspicion of cancer or infection, 81% were false-positive. 59% of the follow-up MRIs on those suspicious findings were false positives. (2) MRI imaging may mislead. For example, MRI demonstrates that the presence of disc degeneration in asymptomatic persons – persons with no back pain – increases with age:  37% in 20 year olds and 96% in 80 year olds; disc bulges: 30% to 84%; disc protrusion: 29% to 43%; annular fissures 19% to 29%. These imaging findings suggest that these are signs of normal aging. They remind all doctors, remind chiropractors like yours at Dr. Butwell, to compare all such findings to patient symptoms. (1,3) Your Georgetown chiropractor does this!


Choosing Wisely guidelines for American chiropractors suggest30 not repeating spinal imaging and not obtaining spinal imaging for patients with acute low back pain in the first 6 weeks of back pain (unless there are “red flags” – issues that indicate something more sinister). (4) A review of the efficacy of the Canadian Choosing Wisely recommendations for imaging nonspecific spinal pain and symptoms reported that there is very low risk of missing a serious cause of back pain. (5) The objective of guidelines is less imaging, fewer false positives.  Dr. Butwell wants what’s best for our Georgetown chiropractic care patients.


Chiropractors like yours at Dr. Butwell review all the symptoms, tests and images our Georgetown chiropractic back pain patients [[present on|bring with them39] their first Georgetown chiropractic visit. So many back pain patients present to Dr. Butwell with MRI images already in-hand. Dr. Butwell will study them but will depend more on clinical exam findings and link them to what the MRI shows. A rule of thumb with the Cox Technic System of Back Pain Relief is to work toward 50% reduction of back pain in the first month of care before arranging more imaging or testing or referring for surgical consultation. (6)

CONTACT Dr. Butwell

Listen to this PODCAST with Dr. Dan Clark on the Back Doctor’s Podcast with Dr. Michael Johnson as he explains the role of imaging for back pain in the program of treatment for pain relief.

Schedule your Georgetown chiropractic appointment with Dr. Butwell today. Let’s discover together the best path to Georgetown back pain relief – with or without MRI imaging!

Dr. Butwell carefully decides when and if MRI images are needed to guide the Georgetown chiropractic treatment plan.