This study aimed to compare diagnostic performance and reporting efficiency for evaluating degenerative musculoskeletal conditions of the lumbar spine of a structured template against the free-narrative approach.

We developed a structured reporting template through interdisciplinary consensus assessing the key categories spinal canal stenosis, disc herniation, neuroforaminal stenosis, recess stenosis, alignment, and activated arthrosis. A 2nd-year radiology resident and a senior radiologist read the lumbar spine MRI of seventy-eight patients using the structured and free-narrative report reading approach in a blinded manner. The reports of a third, subspecialized senior radiologist in consensus with the initial clinical reports constituted the gold standard. We statistically compared the primary outcomes reporting time, diagnostic accuracy in the key categories, and diagnostic confidence between structured and free-narrative report reading.

Structured reporting significantly reduced reporting time (8 vs. 21 min) and diagnostic confidence of the resident. In reporting of the resident, the structured approach yielded higher accuracy in neuroforaminal stenosis (p = 0.0002), higher sensitivity in spinal canal stenosis (p = 0.0156) and disc herniation (p = 0.0010), but lower specifity and accuracy in disc herniations (p = 0.0001, and p = 0.0011). The senior radiologist performed overall better with free-narrative report reading, mainly due to better specifity.

Structured reporting may enhance diagnostic confidence and reduce reporting time for residents, making it particularly valuable in early training stages. However, experienced radiologists may not benefit in terms of efficiency. Free-narrative reports retain advantages in identifying subtle findings, highlighting the importance of a balanced integration of both methods in clinical practice.