Mishra Shruti, Srinivasan Ashok, Kelsey Lauren, Bojicic Katherine, Masotti Maria, Chen Qiaochu, Hoeffner Ellen, Kronick Steven, Gomez-Hassan Diana
Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
Neuroradiol J. 2025 Feb;38(1):79-86. doi: 10.1177/19714009241269540. Epub 2024 Aug 8.
BACKGROUND & PURPOSE: (1) Evaluate efficacy of an abbreviated total spine protocol in triaging emergency department (ED) patients through retrospective evaluation. (2) Describe patient outcomes following implementation of a rapid cord compression protocol.
(1) All contrast-enhanced total spine magnetic resonance imaging studies (MRIs) performed on ED patients ( = 75) between 10/1-12/31/2022 for evaluation of cord compression were included. Two readers with 6 and 5 years of experience blindly reviewed the abbreviated protocol (comprised of sagittal T2w and axial T2w sequences) assessing presence of cord compression or severe spinal canal stenosis. Ground truth was consensus by a neuroradiology fellow and 2 attendings. (2) The implemented rapid protocol included sagittal T1w, sagittal T2w Dixon and axial T2w images. All ED patients ( = 85) who were imaged using the rapid protocol from 5/1-8/31/2023 were included. Patient outcomes and call-back rates were determined through chart review.
(1) Sensitivity and specificity for severe spinal canal stenosis and/or cord compression was 1.0 and 0.92, respectively, for reader 1 and 0.78 and 0.85, respectively, for reader 2. Negative predictive value was 1.0 and 0.97 for readers 1 and 2, respectively. (2) The implemented rapid cord compression protocol resulted in 60% reduction in imaging time at 1.5T. The call-back rate for additional sequences was 7%. In patients who underwent surgery, no additional MRI images were acquired in 82% of cases (9/11).
Implementing an abbreviated non-contrast total spine protocol in the ED results in a low call-back rate with acquired MRI images proving sufficient for both triage and treatment planning in most patients.
（1）通过回顾性评估，评价一种简化的全脊柱检查方案在急诊科患者分诊中的有效性。（2）描述实施快速脊髓压迫检查方案后的患者结局。
（1）纳入2022年10月1日至12月31日期间在急诊科对75例患者进行的所有用于评估脊髓压迫的对比增强全脊柱磁共振成像（MRI）研究。两位分别有6年和5年经验的阅片者对简化方案（由矢状位T2加权和轴位T2加权序列组成）进行盲法评估，判断是否存在脊髓压迫或严重椎管狭窄。真实情况由一名神经放射科住院医师和两名主治医师共同确定。（2）实施的快速方案包括矢状位T1加权、矢状位T2加权 Dixon和轴位T2加权图像。纳入2023年5月1日至8月31日期间使用该快速方案进行成像的所有85例急诊科患者。通过病历审查确定患者结局和召回率。
（1）阅片者1对严重椎管狭窄和/或脊髓压迫的敏感性和特异性分别为1.0和0.92，阅片者2分别为0.78和0.85。两位阅片者的阴性预测值分别为1.0和0.97。（2）实施的快速脊髓压迫方案使1.5T时的成像时间减少了60%。额外序列的召回率为7%。在接受手术的患者中，82%（9/11）的病例未获取额外的MRI图像。
在急诊科实施简化的非对比全脊柱检查方案可使召回率较低，所获取的MRI图像在大多数患者中足以用于分诊和治疗计划。
