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Magnetic Resonance Imaging in Infantile Idiopathic Scoliosis: Is Universal Screening Necessary?
Anthony Kouri1, Joseph S Herron1, Nathaniel Lempert1
1University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH 43614, USA.
Insights
A Cobb angle greater than 29.5° in infantile idiopathic scoliosis (IIS) patients may indicate a higher likelihood of neural axis abnormalities (NAAs), potentially guiding magnetic resonance imaging (MRI) screening decisions for this condition.
Area of Science:
- Pediatric Orthopedics
- Neuroradiology
- Spinal Imaging
Background:
- Infantile idiopathic scoliosis (IIS) presents a diagnostic challenge due to an increased incidence of neural axis abnormalities (NAAs).
- Current guidelines recommend screening magnetic resonance imaging (MRI) for all presumed IIS patients, despite associated costs and risks.
- Identifying a subset of patients who may not require immediate MRI could optimize resource allocation and reduce patient burden.
Purpose of the Study:
- To determine if a specific subgroup of infantile idiopathic scoliosis (IIS) patients exhibits a low incidence of neural axis abnormalities (NAAs).
- To investigate whether radiographic parameters can predict the necessity of screening magnetic resonance imaging (MRI) in presumed IIS patients.
- To identify a potential threshold for spinal curvature that correlates with an increased likelihood of NAAs.
Main Methods:
- Retrospective chart review of 53 presumed IIS patients (onset ≤3 years) who underwent screening MRI.
- Collection of demographic and radiographic data, including Cobb angle measurements.
- Binary regression and receiver operating characteristic (ROC) analysis to assess predictive value of parameters for NAAs.
Main Results:
- A 24.5% incidence of NAAs was observed in the study cohort.
- Patients with Cobb angles >29.5° had a significantly higher incidence of NAAs (39%) compared to those with Cobb angles <29.5° (0%).
- A Cobb angle >29.5° was associated with a 27-fold increased likelihood of NAAs (OR = 27.0, p = .03), while no other parameters showed predictive value.
Conclusions:
- This study identifies Cobb angle as a potential radiographic predictor for identifying IIS patients who may benefit from MRI screening.
- The findings suggest that a Cobb angle threshold of 29.5° could help stratify risk for NAAs in presumed IIS.
- The reported incidence of NAAs (24.5%) in this IIS cohort is higher than previously documented, underscoring the importance of careful screening.
Study Design:
Retrospective chart review.
Objective:
Determine if there is a subset of presumed infantile idiopathic scoliosis (IIS) patients who have a low incidence of neural axis abnormalities (NAAs) such that screening magnetic resonance imaging (MRI) may be delayed.
Summary Of Background Data:
Individuals with presumed IIS have an increased incidence of NAA. Because of the increased incidence, screening MRI is recommended for all patients. We follow these guidelines at our institution. However, MRI screening in this age group is not without cost or risk.
Methods:
This is a retrospective study of 53 presumed IIS (onset ≤3 years) patients who had screening MRIs. Demographic and radiographic characteristics were collected. A binary regression using continuous and categorical variables was used to determine if a model could be created to accurately predict MRI necessity. A receiver operating characteristic (ROC) analysis was performed to determine if a threshold Cobb angle exists that is associated with an increased likelihood of NAA.
Results:
Of the 53 patients, 13 had NAA findings, resulting in a 24.5% incidence of NAAs. Significantly fewer abnormal MRIs were found in patients with Cobb angles <29.5° than those with Cobb angles >29.5° (13/33 [39%] vs. 0/20 [0%], p = .0008). Patients with Cobb angles >29.5° were 27 times more likely to have NAAs than those with angles <29.5° (odds ratio = 27.0 [95% CI = 1.5-486.0], p = .03). No other parameters have a predictive value for NAA (p > .05).
Conclusion:
This is the first study in IIS patients to identify a radiographic parameter that helps select out a subgroup for MRI screening. Additionally, we report an incidence of 24.5% NAAs in these patients, which is higher than previously reported.
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