From the Departments of Radiology (C.W.C.H., A.A., Y.-M.C., A.F.B., D.B.H., R.A.B.).
Department of Radiology (C.W.C.H.), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
AJNR Am J Neuroradiol. 2020 Jun;41(6):1120-1125. doi: 10.3174/ajnr.A6578. Epub 2020 May 21.
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.
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.
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 = 99, < .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 = 3.1, < .001) and in <24-hours (OR = 2.6, = .01) compared with those with either a high-risk clinical profile or neurologic findings alone (179/321).
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.
当基于病史或临床发现无法下达针对性影像学检查时，急诊会要求进行全脊柱 MRI 检查。然而，目前尚不清楚这种检查的效果如何。我们评估了以下内容：1）急诊行全脊柱 MRI 的主要影像学和临床结局，2）高危临床特征和/或神经学表现是否会影响临床结局。
在 28 个月的时间内，我们评估了急诊要求行全脊柱 MRI 的患者，以评估主要影像学（脊髓压迫、马尾神经压迫和其他重要发现）和主要临床结局（就诊期间住院并接受手术、放疗或静脉用抗生素或类固醇治疗）。评估了高危临床特征（癌症、感染、凝血功能障碍）和/或神经学表现与结局之间的相关性。
排除创伤或无诊断价值的研究后，在研究期间要求行的 2047 例 MRI 中，有 321 例（15.7%）为全脊柱 MRI；117 例（36.4%）有主要影像学发现，60 例（18.6%）有主要临床结局（34 例在 24 小时内出现）；117 例有主要影像学发现的患者中，58 例（49.6%）接受了治疗，而 205 例无主要影像学发现的患者中仅 2 例（1.0%）接受了治疗（OR=99，<0.001）。如果患者同时存在高危临床特征和神经学表现（142/321），则其在就诊时出现主要临床结局（OR=3.1，<0.001）和在 24 小时内出现主要临床结局（OR=2.6，=0.01）的可能性均高于仅有高危临床特征或神经学表现的患者（179/321）。
我院急诊要求行全脊柱 MRI 检查的检查结果有较高的影像学和临床意义。如果患者同时存在高危临床特征和神经学表现，应优先考虑行全脊柱 MRI 检查，因为其出现临床影响的可能性更高。
