Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center

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FIG 1.
A 67-year-old woman with a history of breast cancer presented with bilateral lower extremity and right upper extremity weakness. The upper portion of total spine MR imaging with T2-weighted sagittal (A) and axial (B) images shows severe compression of the spinal cord at the T4 level with no CSF visualized within the spinal canal at that level.
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FIG 2.
An 83-year-old man presenting with lower back pain, leg numbness, leg weakness, and urinary retention. T2-weighted sagittal (A) and axial (B) images from total spine MR imaging show a herniated L4–L5 intervertebral disc causing severe spinal canal stenosis with a lack of CSF within the thecal sac, suggesting cauda equina compression.
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FIG 3.
A 41-year-old man with a history of intravenous drug use presenting with fever, severe diffuse back pain, and right lower quadrant abdominal pain. The lower portion of total spine MR imaging with T1-weighted postcontrast sagittal (A) and axial (B) images shows discitis and osteomyelitis, with epidural and right paraspinal phlegmon.

Table 1:

Radiologic and clinical outcomes of TS-MR imaging^{^a}

Radiologic Outcomes of TS-MR Imaging with Major Radiologic Outcome	(N = 321) 117/321 (36.4%)	Major Clinical Outcome in Patients, (n = 60/321) (18.6%)
	(N = 321) 117/321 (36.4%)	During Visit 58/117 (49.6%)^{^b}	<24 Hours 33/117 (28.2%)^{^c}
SCC or CEC	72	36	20
Degenerative disease	41	12	3
Neoplasm	16	12	5
Infection	10	10	10
Hematoma	2	2	2
Iatrogenic	1	0	0
Traumatic findings	2	0	0
Other significant findings	45	22	13
Neoplasm	19	8	1
Infection	8	8	8
Iatrogenic	1	1	1
Spinal cord lesion	7	3	3
Traumatic findings	3	0	0
Extraspinal findings^{^d}	7	2	0
Without major radiologic outcome	204/321 (63.6%)	2/204 (1.0%)^{^b}	1/204 (0.5%)^{^c}

Note:—Bold indicates total of subsequent raws respectively.
↵a Clinical Outcome: hospital admission followed by an operation, radiation, IV therapy (antibiotics or steroids), or abscess drainage during same visit as well as in <24 hours and >24 hours after arrival to ED.
↵b Odds Ratio = 99 (95% CI, 23.5–419; P value < .001) between patients with and without major radiologic outcomes.
↵c Odds Ratio = 80 (95% CI, 10.7–593; P value < .001) between patients with and without major radiologic outcomes.
↵d Psoas muscle abscess and lymphoma.

Table 2:

Impact of HRCP and neurologic findings on major clinical outcomes^{^a}

Variable	No. of Patients (N = 321)	During Visit	Odds Ratio (95% CI)	P Value	<24 Hours	Odds Ratio (95% CI)	P Value
HRCP + NF	142/321 (44%)	40/142 (28%)	3.1 (1.7–5.6)	<.001	22/142 (15%)	2.6 (1.2–5.4)	.01
HRCP or NF alone	179/321 (56%)	20/179 (11%)			12/179 (7%)

Note:—NF indicates neurologic findings.
↵a Major clinical outcomes of patients who had both HRCP + NF were compared with patients who had either HRCP or NF alone.