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[Limitation of MRI in the diagnosis of the spinal cord and spine disorders].

Here, we review of the efficacy of radioimaging method in the diagnosis of the spinal cord and spine disorders. The simplest solution for a successful diagnosis is to scan wide field in each image. Nothing will start unless one recognizes the imaging findings. Analysis based on the MECE principle, mutually exclusive and collectively exhaustive, is performed in four ways, that is deductive, fractionation, longitudinal and priority methods. Because purpose determines the means, structual constructivism suggests that one should employ the appropriate method depending on the situation (interest-correlative approach). The practical conventional procedure to attain a diagnosis is as follows. First identify the location of the lesion by using MRI or other modalities. The location of the lesion shorten the list of differential diagnosis. Second, obtain maximum information on the characteristics of the lesion in order to speculate the pathology. Third, look for any associated findings such as tortuous vasculature around the spinal cord. Fourth, refer to all the available information for example, chief complaint, clinical history, previous history, family history, physical findings, physiological findings, laboratory data, previous images, other modalities and so on. And finally, one should consult with the attending physician and colleagues when in doubt. However, because rationality (mathematical expectation: posterior probability or positive predictive value with positive findings), predicted utility, and emotions affect human beings while making decisions, it seems impossible to completely avoid oversights and misdiagnosis.