When clinical examination suggests the presence of an acute lumbar disc herniation what is the preferred imaging test to confirm the diagnosis

Magnetic resonance imaging (MRI) is the preferred imaging test because it provides the greatest amount of information about the lumbar region. It is unparalleled in its ability to visualize pathologic processes involving the disc, thecal sac, epidural space, neural elements, paraspinal soft tissue, and bone marrow. However, caution is indicated when interpreting results of MRI scans due to the high frequency of disc abnormalities in asymptomatic patients. It is critical to correlate imaging findings with clinical examination. Although lumbar radiographs cannot show a lumbar disc herniation, standing radiographs are advised prior to referral for MRI in order to define regional lumbar anatomy and diagnose other potential pathologies such as spondylolisthesis.

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