Impact of whole spine screening and role of radiologist in taking axial cuts at suspected tandam pathology while doing whole spine screening in the same setting

Abstract

Purpose: Determines the prevalence of incidental findings (IF) which need attention or concurrent treatment i.e. meaningful coexisting spine lesion (MCSL) reported in the MRI’s with spinogram. Determine role of radiologist in providing axial cut at same time in tandem lesions. Also determine what percentage of treating clinician order a spine MRI without a spinogram. Methodology: It is a retrospective analytic study carried out at Department of spine surgery in our institution. Accumulation of data from two MRI centres (A and B) of city done from 1 Jan 2018 to 30September 2019.We blind the identity of all MRI centres as well as the referring clinicians. Of those clinician ordering only regional MRI were counted. MRI centre ‘A’ routinely providing us axial cuts of tandem pathologies of MCSL apart from dedicated area along with whole spine screening in same setting. All number of such reports counted and compared with reports of MRI centre ‘B’ who doing repeat MRI at tandem lesions when we advised only. All the MRIs reports segregate between MRIs with spinogram and only regional or area specific MRI study. Around 2000 MRI films were studied Statistical analysis of data carried out to determine the prevalence of incidental findings of coexisting spine lesion in MRI’s spinogram. Data was analysed using chi square test to determine the correlation between the findings, P value <0.05 considered significant. Results: Total 2000 MRI films were studied in which regional MRI were done in 445 (22.3%) and regional along with whole spine screening were done 1555(77.7%) patients .Around 6 out of 36 (15.7%) treating physician ordered only regional MRI investigations. Number of primary spine lesions seen in area specific MRI 708(45.5%) which were radiologically significant. MRIs with IF of meaningful coexisting spine lesions” (MCSL) 274 (17.6%). Area wise distribution of MCSL were, cervical spine 84(5.2%), thoracic spine24 (1.5%), lumbar spine 168(10.8%). There were 274(17.7%) MCSL lesions out of 1545 MRIs of whole spine group, which was significant (p<.05) compared to number of primer lesion i.e. 708, found in same group. Total number of patients who had done repeat MRI at tandem lesion were 154 of which centre ‘A’ performed 34(20%) and centre ‘B’ 122(79%) which was statically significant. Conclusion: Whole spine MRI screening is useful for diagnosis of coexisting spinal diseases to avoid, missing of an asymptomatic but significant lesion. Considering the potential advantages in identifying significant IF and the minimal extra time spent to perform whole spine screening as well as taking axial cut at same time which save extra time and cost. Its application can be considered to be incorporated along with regional studies of spine. Role of radiologist cannot be neglected in taking axial cuts at Grade 3 and 4 MCSL at same time.