Incidence and significance of findings on spinal MRIs in a paediatric population with spinal column complaints

Abstract

Purpose We sought to identify correlations between working diagnosis, surgeon indication for obtaining spinal MRI and positive MRI findings in paediatric patients presenting with spinal disorders or complaints. Methods Surgeons recorded their primary indication for ordering a spinal MRI in 385 consecutive patients. We compared radiologist-reported positive MRI findings with surgeon response, indication, working diagnosis and patient demographics. Results The most common surgeon-stated indications were pain (70) and coronal curve characteristics (63). Radiologists reported 137 (36%) normal and 248 (64%) abnormal MRIs. In total, 58% of abnormal reports (145) did not elicit a therapeutic or investigative response, which we characterized as ‘clinically inconsequential’. In all, 42 of 268 (16%) presumed idiopathic scoliosis patients had intradural pathology noted on MRI. Younger age (10.3 years versus 12.0 years) was the only significant demographic difference between patients with or without intradural pathology. Surgeon indication ‘curve magnitude at presentation’ was associated with intradural abnormality identification. However, average Cobb angles between patients with or without an intradural abnormality was not significantly different (39° versus 37°, respectively). Back pain without neurological signs or symptoms was a negative predictor of intradural pathology. Conclusion Radiologists reported a high frequency of abnormalities on MRI (64%), but 58% of those were deemed clinically inconsequential. Patients with MRI abnormalities were two years’ younger than those with a normal or inconsequential MRI. ‘Curve magnitude at presentation’ in presumed idiopathic scoliosis patients was the only predictor of intrathecal pathology. ‘Pain’ was the only indication significantly associated with clinically inconsequential findings on MRI. Level of evidence: III

Assessing need for advance imaging among children with back pain using pain intensity as clinical marker

“…In 2019, Ramirez et al 3 refuted the consistency of the clinical markers described above and reopened the search for other, more reliable clinical markers. In 2021, Rathjen et al 14 evaluated the relationship between back pain and the presence of underlying MRI intradural pathology. They found that back pain does not have a clinical correlation with the presence of underlying MRI intradural pathology in pediatric patients.…”

“…They found that back pain does not have a clinical correlation with the presence of underlying MRI intradural pathology in pediatric patients. 14 , 15 Amid the lack of available data regarding clinical markers that may predict the presence of underlying pathology, pain intensity was proposed as a reliable marker to predict the presence of underlying pathology.…”

Entire-spine Magnetic Resonance Imaging Findings and Costs in Children With Presumed Adolescent Idiopathic Scoliosis

“…16 However, there is significant debate regarding the utility of clinical factors, 17 with multiple MRI studies demonstrating the poor predictive ability of clinical complaints, 10 no association between severity of pain and incidence of pathologic findings, 18 and an increased rate of inconsequential findings in MRI's ordered for back pain. 11 In this study, 28 patients underwent MRI for "back pain" as the indication. None of these patients demonstrated a neural axis abnormality or any other finding prompting an altered course of treatment.…”

“…This is further reinforced by a recent study which showed that patients with back pain as the primary indication for MRI in the absence of any neurological complaints or findings were most likely to have a normal MRI. 11 While there may be a role for targeted MRI in an area of focal back pain with radicular symptoms, an entire-spine MRI is likely not the most appropriate screening modality for patients with otherwise typical idiopathic scoliosis. A wide range of conservative treatments have shown promise in alleviating back pain in patients with AIS including swimming, home exercises, physical therapy, and medication (including acetaminophen and nonsteroidal anti-inflammatory drugs).…”

“…In addition to monetary costs, identification of incidental findings can lead to significant patient and family anxiety. [6][7][8] As discussed by Rathjen at al, 11 radiologists report abnormalities which do not alter patient care and are considered inconsequential by the treating surgeon (58% of findings in their cohort). However, conversely, there is the potential to identify potentially harmful conditions earlier than might have occurred on the basis of symptoms.…”