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Research ArticleORIGINAL RESEARCH

Implementation of a Survey Spine Magnetic Resonance Imaging Protocol for Cord Compression in the Emergency Department: Experience at a Level-1 Trauma Center

Mercy H. Mazurek, Annie R. Abruzzo, Alexander H. King, Erica Koranteng, Grant Rigney, Winston Lie, Shahaan Razak, Rajiv Gupta, William A. Meehan, Michael H. Lev, Joshua A. Hirsch, Karen Buch and Marc D Succi
American Journal of Neuroradiology May 2024, ajnr.A8326; DOI: https://doi.org/10.3174/ajnr.A8326
Mercy H. Mazurek
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Annie R. Abruzzo
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Alexander H. King
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
MS
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Erica Koranteng
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Grant Rigney
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Winston Lie
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Shahaan Razak
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Rajiv Gupta
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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William A. Meehan
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Michael H. Lev
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Joshua A. Hirsch
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Karen Buch
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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Marc D Succi
From the Harvard Medical School, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA (M.H.M., A.R.A.,A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Department of Radiology, Massachusetts General Hospital, Boston, MA (R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.).
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ABSTRACT

BACKGROUND AND PURPOSE: Imaging stewardship in the emergency department (ED) is vital in ensuring patients receive optimized care. While suspected cord compression (CC) is a frequent indication for total spine MRI in the ED, the incidence of CC is low. Recently, our level-I trauma center introduced a survey spine MRI protocol to evaluate for suspected CC while reducing exam time to avoid imaging overutilization. This study aims to evaluate the time savings, frequency of ordering patterns of the survey, and the symptoms and outcomes of patients undergoing the survey.

MATERIALS AND METHODS: This retrospective study examined patients who received a survey spine MRI in the ED at our institution between 2018 and 2022. All exams were performed on a 1.5T GE scanner using our institutional CC survey protocol, which includes sagittal T2 and STIR sequences through the cervical, thoracic, and lumbar spine. Exams were read by a blinded, board-certified neuroradiologist.

RESULTS: A total of 2,002 patients received a survey spine MRI protocol during the study period. Of these patients, 845 (42.2%, mean age 57 ± 19 years, 45% female) received survey spine MRI exams for the suspicion of CC, and 120 patients (14.2% positivity rate) had radiographic CC. The survey spine MRI averaged 5 minutes and 50 seconds (79% faster than routine MRI). On multivariate analysis, trauma, back pain, lower extremity weakness, urinary or bowel incontinence, numbness, ataxia, and hyperreflexia were each independently associated with CC. Of the 120 patients with CC, 71 underwent emergent surgery, 20 underwent non-emergent surgery, and 29 were managed medically.

CONCLUSIONS: The survey spine protocol was positive for CC in 14% of patients in our cohort and acquired at a 79% faster rate compared to routine total spine. Understanding the positivity rate of CC, the clinical symptoms that are most associated with CC, and the subsequent care management for patients presenting with suspected cord compression who received the survey spine MRI may better inform the broad adoption and subsequent utilization of survey imaging protocols in emergency settings to increase throughput, improve allocation of resources, and provide efficient care for patients with suspected CC.

ABBREVIATIONS: CC, cord compression; ED, emergency department; MRI, magnetic resonance imaging; T2; T2-weighted imaging sequence; STIR, short TI inversion recovery.

Footnotes

  • All authors declare no conflicts of interest related to the content of this article. MDS is the Founder and CEO, 2 Minute Medicine, Inc. Inventor, patents licensed to Frequency Therapeutics. President, Isernia Labs, LLC. RG would like to disclose the following interests that are unrelated to the current paper: Scientific Advisory Board: Bayer HealthCare LLC, BrainTale Inc, Agfa HealthCare Inc; Speaker honorarium: Siemens Medical Solutions, USA; Research Grant: Samsung Healthcare; Consulting: Idorsia, Inc, Medtronic Inc, US Attorney's Office, District of Colorado.

  • © 2024 by American Journal of Neuroradiology
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Accepted Manuscript
Mercy H. Mazurek, Annie R. Abruzzo, Alexander H. King, Erica Koranteng, Grant Rigney, Winston Lie, Shahaan Razak, Rajiv Gupta, William A. Meehan, Michael H. Lev, Joshua A. Hirsch, Karen Buch, Marc D Succi
Implementation of a Survey Spine Magnetic Resonance Imaging Protocol for Cord Compression in the Emergency Department: Experience at a Level-1 Trauma Center
American Journal of Neuroradiology May 2024, ajnr.A8326; DOI: 10.3174/ajnr.A8326

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Accepted Manuscript
Implementation of a Survey Spine Magnetic Resonance Imaging Protocol for Cord Compression in the Emergency Department: Experience at a Level-1 Trauma Center
Mercy H. Mazurek, Annie R. Abruzzo, Alexander H. King, Erica Koranteng, Grant Rigney, Winston Lie, Shahaan Razak, Rajiv Gupta, William A. Meehan, Michael H. Lev, Joshua A. Hirsch, Karen Buch, Marc D Succi
American Journal of Neuroradiology May 2024, ajnr.A8326; DOI: 10.3174/ajnr.A8326
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