Akademik Veri Yönetim Sistemi
European Congress of Radiology, Vienna, Avusturya, 6 - 10 Mart 2014, cilt.5, sa.969, ss.369
Spinal MRI is a well known, traditional approach for the evaluation of spinal anatomy, variations, congenital malformations and various pathologies (1,2). Patients are usually referred to spinal MRI for the diagnosis of the herniated intervertebral disc disease which may explain the radicular pain in the lumbar area. Radiologists generally focus primarily on spinal findings and extraspinal findings can be overlooked. The aim of this study is to analyse the affect of picture archiving and communication system (PACS) on the number of reported extraspinal findings in lumbar MRI examinations.
Lumbar spinal MRI reports of the pre-PACS period and the post-PACS period were retrospectively evaluated. Patients with the complaints of backpain or radiating pain were included in the study. Patients with a history of acute trauma or myelopathies (multipl sclerosis, transverse myelitis etc.) were excluded from the study. MRI procedures were performed at 1.5 Tesla (Superconductive MRI System, Siemens Magnetom Vision Plus, Siemens, Erlangen) by the application of body coils. A sagittal T1-weighted (W) spin echo (SE), sagittal T2W turbo spin echo (TSE) and axial T2W fast-field echo (FFE) sequences were obtained in the standard spinal MRI protocole.
In the pre-PACS period 2260 and in the post-PACS period 1871 lumbar spinal MRI reports were reviewed. In the pre-PACS period among 2260 spinal MRI examinations, 275 extraspinal pathologies were reported in 12.16% of the patients whereas in the post-PACS period among 1871 spinal MRI examinations 538 extraspinal pathologies were detected in 28.75% of the patients. The most common extraspinal findings were the genitourinary system pathologies. According to the differences between two proportions test the increase in the number of reported extraspinal findings was statistically significant (p=0.0012<0.05).
Various extraspinal findings might first be detected during spinal MRI examinations (Figure 1,2,3). Some of these findings might be life-threatening and patients might need immediate intervention. Thus it is crucial for the radiologist not to focus only to the spinal canal and vertebra but try to analyse the whole region from a broader perspective. PACS enables the radiologists to analyse from a broader field of view with uncropped soft copy images and provides the ability of changing the image parameters. With the wider implementation of PACS the number of reported incidental findings will potentially increase. In our study the prevalence of the extraspinal findings was about 133% higher after the installation of PACS. This big difference between the prevalences of the extraspinal findings of the pre-PACS period and post-PACS period emphasizes the benefits of reporting from soft copy images at PACSworkstations where radiologists have access to uncropped full-FOV images. PACS presents more diagnostic information for the radiologists. The ultimate effect of the diagnosis of the incidental findings is unknown (3).
1. Jindal G, Pukenas B. Normal spinal anatomy on magnetic resonance imaging. Magn Reson Imaging Clin N Am. 2011 Aug;19(3):475-88.
2. Rufener S, Ibrahim M, Parmar HA. Imaging of congenital spina and spinal cord malformations. Neuroimaging Clin N Am. 2011 Aug;21(3):659-76.
3. Westbrook JI, Braightwaite J, McIntosh JH. Incidental lesions: serendipitous or iatrogenic? AJR 1998;171:1193-1196.