RT Journal Article SR Electronic T1 Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 1120 OP 1125 DO 10.3174/ajnr.A6578 VO 41 IS 6 A1 C.W.C. Huang A1 A. Ali A1 Y.-M. Chang A1 A.F. Bezuidenhout A1 D.B. Hackney A1 J.A. Edlow A1 R.A. Bhadelia YR 2020 UL http://www.ajnr.org/content/41/6/1120.abstract AB BACKGROUND AND PURPOSE: Total spine MRIs are requested by the emergency department when focused imaging can not be ordered on the basis of history or clinical findings. However, their efficacy is not known. We assessed the following: 1) major radiologic and clinical outcomes of total spine MR imaging performed by the emergency department, and 2) whether the presence of a high-risk clinical profile and/or neurologic findings impacts the clinical outcomes.MATERIALS AND METHODS: Total spine MRIs requested by the emergency department during a 28-month period were evaluated for major radiologic (cord compression, cauda equina compression, and other significant findings) and major clinical outcomes (hospital admission during the visit followed by an operation, radiation therapy, or intravenous antibiotics or steroids). Associations between a high-risk clinical profile (cancer, infection, coagulopathy) and/or the presence of neurologic findings and outcomes were assessed.RESULTS: After we excluded trauma or nondiagnostic studies, 321/2047 (15.7%) MRIs ordered during study period were total spine MR imaging; 117/321 (36.4%) had major radiologic and 60/321 (18.6%) had major clinical outcomes (34/60 in <24 hours); and 58/117(49.6%) with major radiologic outcome were treated compared with 2/205 (1.0%) without (OR = 99, P < .001). The presence of both a high-risk clinical profile and neurologic findings concurrently in a patient (142/321) increased the likelihood of major clinical outcomes during the same visit (OR = 3.1, P < .001) and in <24-hours (OR = 2.6, P = .01) compared with those with either a high-risk clinical profile or neurologic findings alone (179/321).CONCLUSIONS: Total spine MR imaging ordered by our emergency department has a high radiologic and significant clinical yield. When a high-risk clinical profile and neurologic findings are both present in a patient, they should be prioritized for emergent total spine MR imaging, given the increased likelihood of clinical impact.CECcauda equina compressionEDemergency departmentHRCPhigh-risk clinical profileSCCspinal cord compressionTStotal spine