Evaluating rapid spine MRI in pediatric imaging: utility, outcomes, and patient selection

Rapid spine MRI offers a sedation-free alternative for pediatric imaging, minimizing the risks associated with sedation for diagnostic imaging of suspected spinal anomalies. This study was designed to evaluate the clinical utility of this modality through analysis of imaging outcomes and patient selection to inform its integration into pediatric imaging protocols.

In this retrospective study, the authors reviewed chart data from pediatric patients diagnosed with congenital malformations of the spine, spinal cord, or both between January 1, 2014, and October 25, 2024, who were under 18 years of age and had undergone at least one rapid or one regular MRI evaluation. Variables included were demographic characteristics, conversion from rapid MRI to regular MRI, need for further imaging, and clinical outcomes. Analyses included the t-test, chi-square test, and logistic regression with variance inflation factor adjustment to identify predictors of outcomes.

Among 788 patients, 151 underwent initial rapid MRI and 637 underwent initial regular MRI. Patients who received rapid MRI were younger (43.7 ± 67.9 months vs 56.5 ± 97.7 months, p = 0.001) and had longer hospital stays after surgery (9.02 ± 23.73 days vs 3.56 ± 8.62 days, p = 0.002). On multivariate regression analysis, significant positive predictors of conversion to regular MRI or need for further imaging included lower body mass index (BMI) (β = -0.255, p = 0.002), developmental delays (β = 1.772, p < 0.001), and leg weakness (β = 1.789, p = 0.036). Rapid MRI patients required more further imaging (β = 1.680, p < 0.001) but fewer surgical interventions (β = -1.393, p < 0.001). There was no significant difference between rates of conversion to rapid MRI or return to regular MRI.

Rapid MRI is a valuable alternative to conventional MRI in pediatric neurosurgery, particularly for patients in whom sedation poses an elevated risk. In this cohort, lower BMI, leg weakness, and developmental delays were predictors of the need for further imaging. These findings support the targeted use of rapid MRI in select pediatric populations for whom further imaging would not be necessary in order to reduce sedation exposure during first-line imaging.