Noor Muhammad Ashhad, Al-Ashqar Mohammad, Abul Ahmad, Grayston James, Nisar Sohail, Loughenbury Peter R, Radcliffe Graham
Department of Medicine and Surgery, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR.
Department of Trauma and Orthopaedics, Yorkshire and Humber Deanery, Leeds, GBR.
Cureus. 2024 Jan 28;16(1):e53100. doi: 10.7759/cureus.53100. eCollection 2024 Jan.
Magnetic resonance imaging (MRI) is the gold standard investigation for lumbosacral degenerative disc disease. However, there is controversy regarding the clinical value of repeating an MRI scan within 12 months when a patient presents with recurring or changing symptoms. This study measures rates of radiological change in a real-world cohort to guide clinicians when deciding to repeat a scan.
All patients over a 10-year window in one general hospital who underwent two lumbosacral MRI scans for degenerative disc disease within 12 months of each other were included in the study. All MRI reports were manually reviewed. The level of main vertebral pathology was recorded, along with the location of a disc prolapse. Time intervals between the two scans were calculated, and these were collated into 30-day intervals for analysis. The repeat scans were categorized into three groups: no change, radiological improvement, and radiological deterioration. Patients who had clinically significant deterioration in the form of cauda equina compression on MRI scans were recorded.
Four hundred and eighty-one patients were included for analysis. Three hundred and ninety (81%) showed no change in MRI findings, 18 (3.7%) had improvements in their repeat scans, and 73 (15.3%) demonstrated deterioration in their repeat scans. Of the 73 patients with radiological deterioration, three patients (0.62% of the total) required urgent surgical intervention for cauda equina syndrome (CES).
Though there is no alternative to detailed clinical assessment in determining whether a repeat MRI scan is indicated, the findings demonstrate that repeating MRI within 12 months for patients with lumbosacral degenerative disc disease has a low chance of altering the management plan. Over the 10-year period, only three patients required an urgent change to their clinical management. We believe this data can help guide clinical decision-making when considering a repeat scan.
磁共振成像（MRI）是腰骶部退行性椎间盘疾病的金标准检查方法。然而，当患者出现复发或变化的症状时，在12个月内重复进行MRI扫描的临床价值存在争议。本研究测量了真实世界队列中的影像学变化率，以指导临床医生决定是否重复扫描。
本研究纳入了一家综合医院10年内所有因退行性椎间盘疾病在12个月内接受两次腰骶部MRI扫描的患者。所有MRI报告均进行人工审核。记录主要椎体病变的水平以及椎间盘突出的位置。计算两次扫描之间的时间间隔，并将其整理为30天的间隔进行分析。重复扫描分为三组：无变化、影像学改善和影像学恶化。记录MRI扫描显示马尾神经受压且临床症状明显恶化的患者。
481例患者纳入分析。390例（81%）MRI结果无变化，18例（3.7%）重复扫描有改善，73例（15.3%）重复扫描显示恶化。在73例影像学恶化的患者中，3例（占总数的0.62%）因马尾神经综合征（CES）需要紧急手术干预。
虽然在确定是否需要重复MRI扫描时，详细的临床评估无可替代，但研究结果表明，腰骶部退行性椎间盘疾病患者在12个月内重复进行MRI扫描改变治疗方案的可能性较低。在这10年期间，只有3例患者需要紧急改变临床治疗方案。我们认为这些数据有助于在考虑重复扫描时指导临床决策。
