Implementing a rapid cord compression Magnetic Resonance Imaging protocol in the emergency department: Lessons...

Area of Science:

• Radiology
• Emergency Medicine
• Neurology

Background:

• Emergency department (ED) patients often require urgent spinal imaging.
• Evaluating cord compression necessitates comprehensive magnetic resonance imaging (MRI) protocols.
• Optimizing ED imaging workflows is crucial for timely patient care.

Purpose of the Study:

• To assess the diagnostic accuracy of a shortened total spine MRI protocol for triaging ED patients.
• To evaluate patient outcomes and imaging efficiency after implementing a rapid cord compression protocol.

Main Methods:

• Retrospective review of 75 total spine MRIs using an abbreviated protocol (sagittal T2w, axial T2w) for cord compression assessment.
• Prospective analysis of 85 ED patients imaged with a rapid protocol (sagittal T1w, sagittal T2w Dixon, axial T2w).
• Reader assessment of cord compression and spinal stenosis, followed by chart review for patient outcomes and call-back rates.

Main Results:

• The abbreviated protocol demonstrated high sensitivity (0.78-1.0) and specificity (0.85-0.92) for cord compression and stenosis.
• The rapid protocol reduced imaging time by 60% and had a 7% call-back rate for additional sequences.
• In surgical cases, 82% of patients did not require additional MRI sequences.

Conclusions:

• An abbreviated, non-contrast total spine MRI protocol is effective for ED patient triage.
• This rapid protocol leads to a low call-back rate and sufficient imaging for treatment planning.
• Implementing this protocol streamlines emergency care for suspected cord compression.