Much less Is Extra: Efficacy of Fast 3D-T2 SPACE in ED Sufferers with Acute Atypical Low Again Ache.

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Much less Is Extra: Efficacy of Fast 3D-T2 SPACE in ED Sufferers with Acute Atypical Low Again Ache.

Acad Radiol. 2017 Aug;24(eight):988-994

Authors: Koontz NA, Wiggins RH, Mills MK, McLaughlin MS, Pigman EC, Anzai Y, Shah LM

Summary
RATIONALE AND OBJECTIVES: Emergency division (ED) sufferers with acute low again ache (LBP) could current with ambiguous medical findings that pose diagnostic challenges to exclude cauda equina syndrome (CES). As a proof of idea, we aimed to find out the efficacy of a fast lumbar backbone (LS) magnetic resonance imaging (MRI) screening protocol consisting of a single 3D-T2 SPACE FS (3D-T2 Sampling Perfection with Software optimized Contrasts utilizing completely different flip angle Evolution fats saturated) sequence relative to traditional LS MRI to exclude emergently treatable pathologies on this advanced affected person inhabitants.
MATERIALS AND METHODS: LS MRI protocol together with a sagittal 3D-T2 SPACE FS pulse sequence was added to the routine for ED sufferers presenting with acute atypical LBP over a 12-month interval. Imaging findings had been categorically scored on the 3D-T2 SPACE FS sequence and individually on the reference commonplace standard LS MRI sequences. Sufferers’ signs had been obtained from assessment of the digital medical document. Descriptive check statistics had been carried out.
RESULTS: Of the 206 ED sufferers who obtained MRI for acute atypical LBP, 118 (43.three?±?13.5 years of age; 61 feminine) had been included. Particular pathologies detected on reference commonplace standard MRI included disc herniation (n?=?30), acute fracture (n?=?three), synovial cyst (n?=?three), epidural hematoma (n?=?2), cerebrospinal fluid leak (n?=?1), and leptomeningeal metastases (n?=?1), and on a number of events these pathologies resulted in nerve root impingement (n?=?36), extreme spinal canal stenosis (n?=?13), wire/conus compression (n?=?2), and twine sign abnormality (n?=?2). The 3D-T2 SPACE FS sequence was an efficient display screen for fracture (sensitivity [sens]?=?100%, specificity [spec]?=?100%), wire sign abnormality (sens?=?100%, spec?=?99%), and extreme spinal canal stenosis (sens?=?100%, spec?=?96%), and recognized wire compression not seen on reference commonplace. Movement artifact was not seen on the 3D-T2 SPACE FS however famous on eight.5% of standard LS MRI.
CONCLUSIONS: The 3D-T2 SPACE FS sequence MRI is a fast, efficient display screen for emergently actionable pathologies that is likely to be a reason behind CES in ED sufferers presenting with acute atypical LBP. As this abbreviated, extremely delicate sequence requires a fraction of the acquisition time of standard LS MRI, it has the potential of contributing to elevated efficiencies within the radiology division and improved ED throughput.

PMID: 28385420 [PubMed – indexed for MEDLINE]

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