Emergency Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
Am J Emerg Med. 2011 Nov;29(9):978-82. doi: 10.1016/j.ajem.2010.05.004. Epub 2010 Aug 2.
The aim of this study was to estimate the yield of emergency department (ED) magnetic resonance imaging (MRI) in detecting spinal epidural abscess (SEA) and to identify clinical factors predicting positive MRI results.
We examined a cohort of patients who underwent MRI to rule out SEA, followed by a nested case-control comparison of those with positive results and a sample with negative results. A positive result was defined as osteomyelitis, discitis, or SEA. Predictor variables included temperature, presenting complaint, drug abuse status, history of SEA or back surgery, midline back tenderness, neurologic deficit, MRI level, mean white blood cell count, erythrocyte sedimentation rate, and C-reactive protein level.
Fourteen of the 120 available MRIs were excluded; 7 (6.6%) of the remaining 106 were positive. Temperature was 1.1°C higher in cases than controls (95% CI, 0.6-1.7).
Emergency department MRI for suspected SEA has a low yield. Clinical guidelines are needed to improve efficiency.
本研究旨在评估急诊（ED）磁共振成像（MRI）检测脊髓硬膜外脓肿（SEA）的产量，并确定预测 MRI 阳性结果的临床因素。
我们检查了一组接受 MRI 检查以排除 SEA 的患者，随后对阳性结果和阴性结果的样本进行了嵌套病例对照比较。阳性结果定义为骨髓炎、椎间盘炎或 SEA。预测变量包括体温、首发症状、药物滥用状况、SEA 或背部手术史、中线背部压痛、神经功能缺损、MRI 水平、平均白细胞计数、红细胞沉降率和 C-反应蛋白水平。
120 个可获得的 MRI 中有 14 个被排除在外；其余 106 个中，有 7 个（6.6%）为阳性。病例组的体温比对照组高 1.1°C（95%CI，0.6-1.7）。
疑似 SEA 的急诊 MRI 产量较低。需要临床指南来提高效率。
