Colip Charles G, Lotfi Mina, Buch Karen, Holalkere Nagaraj, Setty Bindu N
Boston University Medical Center, 1 Boston Medical Center Pl, Boston, MA, 02118, USA.
Emerg Radiol. 2018 Jun;25(3):247-256. doi: 10.1007/s10140-017-1572-9. Epub 2018 Jan 3.
Spinal MRI is the exam of choice for the workup of patients with suspected spinal infection. In this retrospective study, we assess the value of obtaining contrast-enhanced spinal MRI for patients presenting to the emergency department (ED) with acute back pain and a history of intravenous drug use (IVDU).
A retrospective IRB-approved, HIPAA compliant review of the imaging findings, reports and electronic charts of 167 consecutive IV drug-using patients (M/F = 96:71, mean age = 40 years) that presented to the ED with acute back pain over a 55-month period and underwent contrast-enhanced spinal MRI within 24 h. Fisher's exact test was used to identify statistically significant (p < 0.05) associations with MRI findings.
Evidence of infectious spondylitis was demonstrated on the spinal MRIs of 39.5% (n = 66) of 167 patients, all of whom were admitted, and nearly half (48.5%; 32/66) underwent surgical or percutaneous intervention. Statistically significant differences in the decision to admit, blood cultures, and the type of treatment was demonstrated in patients with findings of spinal infection on MRI (p < 0.05).
Use of emergent spinal MRI in the workup of IVDU patients with acute back pain is justified despite the resultant pressure on MRI scanner, technologist, and interpretation time.
脊柱磁共振成像（MRI）是对疑似脊柱感染患者进行检查的首选方法。在这项回顾性研究中，我们评估了对因急性背痛且有静脉药物使用史（IVDU）而到急诊科（ED）就诊的患者进行增强脊柱MRI检查的价值。
对167例连续的有静脉药物使用史的患者（男/女=96:71，平均年龄=40岁）的影像学检查结果、报告和电子病历进行回顾性研究，该研究经机构审查委员会（IRB）批准且符合健康保险流通与责任法案（HIPAA）规定。这些患者在55个月的时间里因急性背痛到急诊科就诊，并在24小时内接受了增强脊柱MRI检查。采用Fisher精确检验来确定与MRI检查结果有统计学意义（p<0.05）的关联。
167例患者中有39.5%（n=66）的脊柱MRI显示有感染性脊柱炎，所有这些患者均被收治，近一半（48.5%；32/66）接受了手术或经皮介入治疗。MRI显示有脊柱感染的患者在收治决策、血培养和治疗类型方面存在统计学显著差异（p<0.05）。
尽管会给MRI扫描仪、技术人员和解读时间带来压力，但对有急性背痛的IVDU患者进行急诊脊柱MRI检查是合理的。
