Shortened total spine MRI protocol in the detection of spinal cord compression and pathology for emergent settings: a noninferiority study

Abstract

Background and purpose: Spinal cord compression (SCC) requires rapid diagnosis in the emergent setting; however, current MRI protocols may be cumbersome for patients and clinicians. We sought to validate an abbreviated total spine MRI (TS-MRI) protocol using standard non-contrast sequences in the detection of SCC and other clinically significant findings (OCSF).

Methods: Two hundred six TS-MRI scans obtained over a 30-month period for SCC were included. Sagittal T2 (T2_sag), sagittal T1 (T1_sag), and sagittal STIR (IR_sag), as well as axial T2 (T2_ax) images, were individually assessed independently by 2 reviewers for SCC, cauda equina compression (CEC), and OCSF. A protocol consisting of all the sequences was considered the gold standard. Sensitivity and specificity of single and combined MRI sequences for SCC/CEC and OCSF were determined and were tested for noninferiority relative to standard non-contrast sequences using a 5% noninferiority margin.

Results: An abbreviated protocol of IR_sag + T2_ax provided the best performance with sensitivity and specificity of 100% (95%CI, 96.0-100.0) and 98.6% (95%CI, 95.6-99.7) for SCC/CEC and 100.0% (95%CI, 96.7-100.0), and 99.3% (95%CI, 96.6-99.9) for OCSF. The mean difference of sensitivity and specificity between IR_sag + T2_ax and standard protocol was 0.0% (95%CI, 0.0-4.0) and - 2.1% (95%CI, - 5.4 to - 0.6) for SCC/CEC and 0.0% (95%CI, 0.0-3.3) and - 1.5% (95%CI, - 4.8 to - 0.3) for OCSF, all within the noninferiority margin of 5%.

Conclusions: An abbreviated TS-MRI protocol of IR_sag + T2_ax is noninferior to the standard non-contrast protocol, potentially allowing for faster emergent imaging diagnosis and triage.

Keywords: Cauda equina; Cord compression; Total spine MRI.