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

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Abstract

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 (T2sag), sagittal T1 (T1sag), and sagittal STIR (IRsag), as well as axial T2 (T2ax) 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 IRsag + T2ax 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 IRsag + T2ax 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 IRsag + T2ax is noninferior to the standard non-contrast protocol, potentially allowing for faster emergent imaging diagnosis and triage.

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Data availability

Research data is confidential, and it is not available publicly. De-identified data will be provided if requested.

Code availability

Codes will be provided if requested.

Abbreviations

ED:

Emergency department

IRsag :

Sagittal STIR

OCSF:

Other clinically significant findings

SCC/CEC:

Spinal cord compression and/or cauda equina compression

T1sag :

Sagittal T1 weighted

T2sag :

Sagittal T2 weighted

T2ax :

Axial T2 weighted

TS-MRI:

Total spine MRI

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA

    Yu-Ming Chang, Seyed Amir Ebrahimzadeh, Harry Griffin & Rafeeque A. Bhadelia

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  1. Yu-Ming Chang
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  2. Seyed Amir Ebrahimzadeh
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  3. Harry Griffin
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  4. Rafeeque A. Bhadelia
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Contributions

Rafeeque A. Bhadelia and Yu-Ming Chang contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Yu-Ming Chang, Harry Griffin, Seyed Amir Ebrahimzadeh, and Rafeeque A. Bhadelia. The first draft of the manuscript was written by Yu-Ming Chang with comments by all authors. All authors commented on all versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yu-Ming Chang.

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Institutional review board approval for this retrospective study with a waiver of informed consent was obtained.

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Chang, YM., Ebrahimzadeh, S.A., Griffin, H. et al. Shortened total spine MRI protocol in the detection of spinal cord compression and pathology for emergent settings: a noninferiority study. Emerg Radiol 29, 329–337 (2022). https://doi.org/10.1007/s10140-021-01956-9

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  • DOI: https://doi.org/10.1007/s10140-021-01956-9

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