The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis

The clinical indications and added value of obtaining MRI in the acute phase of spinal cord injury (SCI) remain controversial. This review aims to critically evaluate evidence regarding the role of MRI to influence decision-making and outcomes in acute SCI. A systematic review and meta-analysis were...

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Autores principales:	Arash Ghaffari-Rafi, Catherine Peterson, Jose E. Leon-Rojas, Nobuaki Tadokoro, Stefan F. Lange, Mayank Kaushal, Lindsay Tetreault, Michael G. Fehlings, Allan R. Martin
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	spinal cord injury SCI spine trauma magnetic resonance imaging MRI Medicine R
Acceso en línea:	https://doaj.org/article/642df05da8fa424a8f285a420cfe9318
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spelling	oai:doaj.org-article:642df05da8fa424a8f285a420cfe93182021-11-11T17:35:02ZThe Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis10.3390/jcm102149482077-0383https://doaj.org/article/642df05da8fa424a8f285a420cfe93182021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4948https://doaj.org/toc/2077-0383The clinical indications and added value of obtaining MRI in the acute phase of spinal cord injury (SCI) remain controversial. This review aims to critically evaluate evidence regarding the role of MRI to influence decision-making and outcomes in acute SCI. A systematic review and meta-analysis were performed according to PRISMA methodology to identify studies that address six key questions (KQs) regarding diagnostic accuracy, frequency of abnormal findings, frequency of altered decision-making, optimal timing, and differences in outcomes related to obtaining an MRI in acute SCI. A total of 32 studies were identified that addressed one or more KQs. MRI showed no adverse events in 156 patients (five studies) and frequently identified cord compression (70%, 12 studies), disc herniation (43%, 16 studies), ligamentous injury (39%, 13 studies), and epidural hematoma (10%, two studies), with good diagnostic accuracy (seven comparative studies) except for fracture detection. MRI findings often altered management, including timing of surgery (78%, three studies), decision to operate (36%, 15 studies), and surgical approach (29%, nine studies). MRI may also be useful to determine the need for instrumentation (100%, one study), which levels to decompress (100%, one study), and if reoperation is needed (34%, two studies). The available literature consistently concluded that MRI was useful prior to surgical treatment (13 studies) and after surgery to assess decompression (two studies), but utility before/after closed reduction of cervical dislocations was unclear (three studies). One study showed improved outcomes with an MRI-based protocol but had a high risk of bias. Heterogeneity was high for most findings (I<sup>2</sup> > 0.75). MRI is safe and frequently identifies findings alter clinical management in acute SCI, although direct evidence of its impact on outcomes is lacking. MRI should be performed before and after surgery, when feasible, to facilitate improved clinical decision-making. However, further research is needed to determine its optimal timing, effect on outcomes, cost-effectiveness, and utility before and after closed reduction.Arash Ghaffari-RafiCatherine PetersonJose E. Leon-RojasNobuaki TadokoroStefan F. LangeMayank KaushalLindsay TetreaultMichael G. FehlingsAllan R. MartinMDPI AGarticlespinal cord injurySCIspine traumamagnetic resonance imagingMRIMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4948, p 4948 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	spinal cord injury SCI spine trauma magnetic resonance imaging MRI Medicine R
spellingShingle	spinal cord injury SCI spine trauma magnetic resonance imaging MRI Medicine R Arash Ghaffari-Rafi Catherine Peterson Jose E. Leon-Rojas Nobuaki Tadokoro Stefan F. Lange Mayank Kaushal Lindsay Tetreault Michael G. Fehlings Allan R. Martin The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis
description	The clinical indications and added value of obtaining MRI in the acute phase of spinal cord injury (SCI) remain controversial. This review aims to critically evaluate evidence regarding the role of MRI to influence decision-making and outcomes in acute SCI. A systematic review and meta-analysis were performed according to PRISMA methodology to identify studies that address six key questions (KQs) regarding diagnostic accuracy, frequency of abnormal findings, frequency of altered decision-making, optimal timing, and differences in outcomes related to obtaining an MRI in acute SCI. A total of 32 studies were identified that addressed one or more KQs. MRI showed no adverse events in 156 patients (five studies) and frequently identified cord compression (70%, 12 studies), disc herniation (43%, 16 studies), ligamentous injury (39%, 13 studies), and epidural hematoma (10%, two studies), with good diagnostic accuracy (seven comparative studies) except for fracture detection. MRI findings often altered management, including timing of surgery (78%, three studies), decision to operate (36%, 15 studies), and surgical approach (29%, nine studies). MRI may also be useful to determine the need for instrumentation (100%, one study), which levels to decompress (100%, one study), and if reoperation is needed (34%, two studies). The available literature consistently concluded that MRI was useful prior to surgical treatment (13 studies) and after surgery to assess decompression (two studies), but utility before/after closed reduction of cervical dislocations was unclear (three studies). One study showed improved outcomes with an MRI-based protocol but had a high risk of bias. Heterogeneity was high for most findings (I<sup>2</sup> > 0.75). MRI is safe and frequently identifies findings alter clinical management in acute SCI, although direct evidence of its impact on outcomes is lacking. MRI should be performed before and after surgery, when feasible, to facilitate improved clinical decision-making. However, further research is needed to determine its optimal timing, effect on outcomes, cost-effectiveness, and utility before and after closed reduction.
format	article
author	Arash Ghaffari-Rafi Catherine Peterson Jose E. Leon-Rojas Nobuaki Tadokoro Stefan F. Lange Mayank Kaushal Lindsay Tetreault Michael G. Fehlings Allan R. Martin
author_facet	Arash Ghaffari-Rafi Catherine Peterson Jose E. Leon-Rojas Nobuaki Tadokoro Stefan F. Lange Mayank Kaushal Lindsay Tetreault Michael G. Fehlings Allan R. Martin
author_sort	Arash Ghaffari-Rafi
title	The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis
title_short	The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis
title_full	The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis
title_fullStr	The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis
title_full_unstemmed	The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis
title_sort	role of magnetic resonance imaging to inform clinical decision-making in acute spinal cord injury: a systematic review and meta-analysis
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/642df05da8fa424a8f285a420cfe9318
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The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis

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