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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:32-37, January 2007
© 2007 American Society of Neuroradiology

SPINE

Which MR Imaging Sequences Are Necessary in Determining the Need for Radiation Therapy for Cord Compression? A Prospective Study

A.J. Johnson^a, J. Ying^b, T. El Gammal^c, R.D. Timmerman^e, R.Y. Kim^d and B. Littenberg^f

^a Department of Radiology, Indiana University, Indianapolis, Ind
^b Department of Biostatistics, Indiana University, Indianapolis, Ind
^c Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala
^d Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Ala
^e Department of Radiation Oncology, University of Texas Southwestern, Dallas, Tex
^f Departments of Medicine and Nursing, University of Vermont, Burlington, Vt

Address correspondence to Annette J. Johnson, MD, MS, Chief, Neuroradiology Division, Indiana University Department of Radiology, Radiology Education & Research Institute, 714 North Senate Ave, Suite 100, Indianapolis, IN 46202; e-mail: annejohn{at}iupui.edu

Background and PURPOSE: To determine which MR imaging sequences are necessary to assess for spinal metastases.

METHODS: Hypothetical MR imaging interpretations and management plans were made prospectively for consecutive adult cases acquired retrospectively. Standardized MR imaging protocols were independently interpreted by 2 neuroradiologists. MR imaging protocol types varied: 1) T1-weighted images only; 2) T1-weighted and T2-weighted images; 3) T1-weighted and postcontrast T1-weighted images; and 4) T1- and T2-weighted images and postcontrast T1-weighted images. Hypothetical management plans were created by 2 radiation oncologists. Logit model was used to investigate the effect of MR imaging protocol type on the probability of recommending radiation therapy (RT). Mixed effect models were used to investigate whether median spinal level or total number of spinal levels of planned RT was associated with MR imaging protocol type.

RESULTS: Thirty-one subjects were evaluated, each with multiple scan interpretations. Logit model showed that neither MR imaging protocol type nor neuroradiologist reader affected the probability that the oncologist would recommend RT (all P > .50). Mixed models showed that neither ML nor NL was affected by MR imaging protocol type or by neuroradiologist reader (all P > .12).

CONCLUSION: Although MR imaging is known to be the most useful diagnostic test in suspected spinal cord compression, which particular MR images are necessary remain unclear. Compared with T1-weighted images alone, the additional use of T2-weighted and/or postcontrast T1-weighted sequences did not significantly affect the probability that RT would be recommended or the levels that would be chosen for RT in our study. Our data suggest that unenhanced T1-weighted images may be sufficient for evaluation of possible cord compression.