Emergent, After Hours Magnetic Resonance Imaging of the Spine

Black, David F.; Wood, Christopher P.; Wells, Michael; Erickson, Bradley J.; Diehn, Felix E.; Kaufmann, Timothy J.; Rydberg, Charlotte H.; Gilbertson, Julie R.; Hunt, Christopher H.

doi:10.1111/jon.12156

Cited by 6 publications

(7 citation statements)

References 8 publications

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“…Previous studies evaluating the radiologic and clinical outcomes of spine MR imaging have generally focused on a single-segment spine study such as cervical or lumbar spine MR imaging. 1,19 Black et al 1 looked at the radiologic and clinical outcomes of 179 emergent spine MRIs during a 13-year period. There were 77 cervical, 87 thoracic, and 101 lumbar spine MR imaging studies, in combination or in isolation, without providing a specific number for TS-MR imaging.…”

Section: Discussionmentioning

confidence: 99%

“…A significant radiologic finding was seen in 104/179 (58%), and 66/179 (36.8%) were treated within 48 hours. 1 Another study by Gardner et al 19 looking only at the lumbar spine for patients with cauda equina syndrome found that 33% of patients with suspected cauda equina syndrome had positive radiologic findings but only 7% received treatment. Both of these studies used different radiologic outcome criteria and different patient populations such as those with mixed single-and multiple-segment MR imaging scans as in the study by Black et al and lumbar spine studies in case of Gardner et al compared with all TS-MR imaging in our study, making it difficult to compare the results.…”

Section: Discussionmentioning

confidence: 99%

“…T wenty-four-hour availability of MR imaging in the United States has significantly increased its use in spine imaging. [1][2][3][4][5][6] Although this may be beneficial in many instances, overuse of imaging has become a concern of both hospital administrators and health care policy makers. 1,7 This concern is based on previous studies that have shown that emergent MR imaging of the spine rarely results in an immediate clinical intervention.…”

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confidence: 99%

“…[1][2][3][4][5][6] Although this may be beneficial in many instances, overuse of imaging has become a concern of both hospital administrators and health care policy makers. 1,7 This concern is based on previous studies that have shown that emergent MR imaging of the spine rarely results in an immediate clinical intervention. 1 Furthermore, it has also been shown that MR imaging of the lumbar spine does not improve overall clinical outcome compared with standard clinical care in patients without "red flags" indicating underlying conditions such as cancer, infection, or cauda equina syndrome.…”

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confidence: 99%

“…1,7 This concern is based on previous studies that have shown that emergent MR imaging of the spine rarely results in an immediate clinical intervention. 1 Furthermore, it has also been shown that MR imaging of the lumbar spine does not improve overall clinical outcome compared with standard clinical care in patients without "red flags" indicating underlying conditions such as cancer, infection, or cauda equina syndrome. 8 Because clinical symptoms and physical examination are often inconsistent and inadequate in identifying and localizing spinal pathology in patients presenting with neck or back pain and neurologic deficits, 4,[9][10][11] MR imaging is frequently ordered for patients in the emergency department (ED).…”

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confidence: 99%

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Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center

Huang

Ali²,

Chang³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Total spine MRIs are requested by the emergency department when focused imaging can not be ordered on the basis of history or clinical findings. However, their efficacy is not known. We assessed the following: 1) major radiologic and clinical outcomes of total spine MR imaging performed by the emergency department, and 2) whether the presence of a high-risk clinical profile and/or neurologic findings impacts the clinical outcomes. MATERIALS AND METHODS:Total spine MRIs requested by the emergency department during a 28-month period were evaluated for major radiologic (cord compression, cauda equina compression, and other significant findings) and major clinical outcomes (hospital admission during the visit followed by an operation, radiation therapy, or intravenous antibiotics or steroids). Associations between a high-risk clinical profile (cancer, infection, coagulopathy) and/or the presence of neurologic findings and outcomes were assessed.RESULTS: After we excluded trauma or nondiagnostic studies, 321/2047 (15.7%) MRIs ordered during study period were total spine MR imaging; 117/321 (36.4%) had major radiologic and 60/321 (18.6%) had major clinical outcomes (34/60 in ,24 hours); and 58/117 (49.6%) with major radiologic outcome were treated compared with 2/205 (1.0%) without (OR ¼ 99, P , .001). The presence of both a high-risk clinical profile and neurologic findings concurrently in a patient (142/321) increased the likelihood of major clinical outcomes during the same visit (OR ¼ 3.1, P , .001) and in ,24-hours (OR ¼ 2.6, P ¼ .01) compared with those with either a high-risk clinical profile or neurologic findings alone (179/321). CONCLUSIONS:Total spine MR imaging ordered by our emergency department has a high radiologic and significant clinical yield. When a high-risk clinical profile and neurologic findings are both present in a patient, they should be prioritized for emergent total spine MR imaging, given the increased likelihood of clinical impact.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center

Huang

Ali²,

Chang³

et al. 2020

AJNR Am J Neuroradiol

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Shortened total spine MRI protocol in the detection of spinal cord compression and pathology for emergent settings: a noninferiority study

et al. 2021

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Background and purpose Spinal cord compression (SCC) requires rapid diagnosis in the emergent setting; however, current MRI protocols may be cumbersome for patients and clinicians. We sought to validate an abbreviated total spine MRI (TS-MRI) protocol using standard non-contrast sequences in the detection of SCC and other clinically significant findings (OCSF). Methods Two hundred six TS-MRI scans obtained over a 30-month period for SCC were included. Sagittal T2 (T2 sag ), sagittal T1 (T1 sag ), and sagittal STIR (IR sag ), as well as axial T2 (T2 ax ) images, were individually assessed independently by 2 reviewers for SCC, cauda equina compression (CEC), and OCSF. A protocol consisting of all the sequences was considered the gold standard. Sensitivity and specificity of single and combined MRI sequences for SCC/CEC and OCSF were determined and were tested for noninferiority relative to standard non-contrast sequences using a 5% noninferiority margin. Results An abbreviated protocol of IR sag + T2 ax provided the best performance with sensitivity and specificity of 100% (95%CI, 96.0-100.0) and 98.6% (95%CI, 95.6-99.7) for SCC/CEC and 100.0% (95%CI, 96.7-100.0), and 99.3% (95%CI, 96.6-99.9) for OCSF. The mean difference of sensitivity and specificity between IR sag + T2 ax and standard protocol was 0.0% (95%CI, 0.0-4.0) and − 2.1% (95%CI, − 5.4 to − 0.6) for SCC/CEC and 0.0% (95%CI, 0.0-3.3) and − 1.5% (95%CI, − 4.8 to − 0.3) for OCSF, all within the noninferiority margin of 5%. Conclusions An abbreviated TS-MRI protocol of IR sag + T2 ax is noninferior to the standard non-contrast protocol, potentially allowing for faster emergent imaging diagnosis and triage.

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Investigation of Whole Spine MRI in the Emergency Department at Two Large Tertiary Care Academic Medical Centers in the United States

Morris

Destian

Chu

et al. 2021

Current Problems in Diagnostic Radiology

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Emergent, After Hours Magnetic Resonance Imaging of the Spine

Abstract: Clinical use of emergent after hours spine MRI is steadily increasing at our institution. While MR imaging often discerned significant pathologies, performing these emergent studies rarely resulted in immediate surgical or radiotherapeutic intervention.

Cited by 6 publications

References 8 publications

Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center

Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center

Shortened total spine MRI protocol in the detection of spinal cord compression and pathology for emergent settings: a noninferiority study

Investigation of Whole Spine MRI in the Emergency Department at Two Large Tertiary Care Academic Medical Centers in the United States

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