MRIs - The Positives and the False Positives

May 22, 2018

Tests – what are they good for?

In the realm of back pain tests, of MRIs that question must be questioned. What are MRIs good for when the percentage of helpful, influential MRI studies is so little? False positive MRI results distress those who get such results. They inspire fear or caution where it is not always warranted. MRIs like this confuse the proper treatment plan. They cost quite a bit. Johnson Chiropractic carefully weighs the necessity of MRI in the Richmond chiropractic treatment plan of Richmond back pain relief.


Interpretations of MRI images by radiologists often vary.  The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1) MRI imaging may produce false suspicion. When following the guidelines of the American College of Radiology, 93% of lumbar spine MRIs were appropriate. Of those, only 13% uncovered anything suspicious. Of the 36 MRIs that provoked 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 shows that the appearance of disc degeneration in asymptomatic persons – persons with no back pain – grows 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 imply that these are signs of normal aging. They remind all doctors, remind chiropractors like yours at Johnson Chiropractic, to correlate all such findings with patient symptoms. (1,3) Your Richmond chiropractor does this!


Choosing Wisely guidelines for American chiropractors recommend not repeating spinal imaging and not getting 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 worrying cause of back pain. (5) The goal of guidelines is less imaging, fewer false positives.  Johnson Chiropractic wants what’s best for our Richmond chiropractic care patients.


Chiropractors like yours at Johnson Chiropractic review all the symptoms, tests and images our Richmond chiropractic back pain patients [[present on|bring with them39] their first Richmond chiropractic visit. So many back pain patients come to Johnson Chiropractic with MRI images already done. Johnson Chiropractic will look at them but will depend more on clinical exam findings and correlate them to what the MRI shows. A rule of thumb with the Cox Technic System of Back Pain Relief is to seek 50% reduction of back pain in the first 30 days of care before ordering more imaging or testing or arranging surgical consultation. (6)

CONTACT Johnson Chiropractic

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 scheme of treatment for pain relief.

Schedule your Richmond chiropractic appointment with Johnson Chiropractic today. Let’s explore together the best path to Richmond back pain relief – with or without MRI imaging!

Johnson Chiropractic carefully decides when and if MRI images are needed to guide the Richmond chiropractic treatment plan.