Clinical evidence of spinal stenosis; or Clinical suspicion of a spinal cord or cauda equina compression syndrome; or Congenital anomalies or deformities of the spine; or Evaluation of recurrent symptoms after spinal surgery; or Evaluation prior to epidural injection to rule out tumor or infection and to delineate the optimal anatomical location for performing the injection; or Follow-up of evaluation for spinal malignancy or spinal infection; or Known or suspected myelopathy e. Clinical guidelines, including those from the Agency for Healthcare Policy and Research, have consistently recommended against routine imaging studies for acute low back pain Cho et al,
Clinical evidence of spinal stenosis; or Clinical suspicion of a spinal cord or cauda equina compression syndrome; or Congenital anomalies or deformities of the spine; or Evaluation of recurrent symptoms after spinal surgery; or Evaluation prior to epidural injection to rule out tumor or infection and to delineate the optimal anatomical location for performing the injection; or Follow-up of evaluation for spinal malignancy or spinal infection; or Known or suspected myelopathy e.
Clinical guidelines, including those from the Agency for Healthcare Policy and Research, have consistently recommended against routine imaging studies for acute low back pain Cho et al, Aetna considers the use of MRI for further evaluation of unstable injury in neurologically intact individuals with blunt trauma after a negative cervical spine CT result not medically necessary.
Aetna considers dynamic-kinetic MRI experimental and investigational for evaluation of the cervical spine because its effectiveness has not been established. Aetna considers the use of routine MRI after a normal CT of the cervical spine in obtunded or comatose individuals experimental and investigational because the clinical value of this approach has not been established.
Background Because of its complexity, the spine is probably the most difficult part of the skeletal system to evaluate radiologically. Improvement of computed tomography CT scanners and the advent of magnetic resonance imaging MRI have changed the approach to diagnostic imaging of the spine.
Previously, invasive modalities were required to obtain information that is now available with non-invasive technologies.
The appropriate use of these new technologies is still somewhat unsettled. The focus is on which test will provide the most accurate and cost effective diagnostic information for each particular clinical situation.
Bulging intervertebral discs have been found in over half of all otherwise asymptomatic adults. It is therefore, important to perform MRI or CT at the right time and to interpret the results in the context of the clinical findings to ensure an accurate diagnosis and avoid unnecessary treatment of conditions that may not be the cause of a patient's symptoms.
For evaluation of recurrent symptoms after spinal surgery, MRI with and without gadolinium enhancement, is the preferred method of imaging. In patients with back pain that cannot be attributed to a specific disease or spinal abnormality following a history and physical examination e.
The American Academy of Family Physicians recommends against do imaging for low back pain within the first six weeks, unless red flags are present. Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected.
Imaging of the lower spine before six weeks does not improve outcomes, but does increase costs. Low back pain is the fifth most common reason for all physician visits.
The North American Spine Society has issued similar recommendations.
Cho et al reported the results of a systematic review and meta-analysis of imaging strategies for LBP without indications of serious underlying conditions. Inclusion criteria were randomized controlled trials that compared immediate, routine lumbar imaging or routine provision of imaging findings versus usual clinical care without immediate lumbar imaging or not routinely providing results of imaging for LBP without indications of serious underlying conditions.
Primary outcomes were improvement in pain or function. Secondary outcomes were improvement in mental health, quality of life, patient satisfaction, and overall improvement. Outcomes were categorized as short-term less than or equal to 3 monthslong-term greater than 6 months to less than or equal to 1 yearor extended greater than 1 year.
Duration of follow-up ranged from 3 weeks to 2 years. Three trials compared immediate lumbar radiography with usual clinical care without immediate lumbar radiography, and 1 compared immediate lumbar radiography with a brief education intervention plus lumbar radiography, if no improvement was seen by 3 weeks.
Two studies assessed advanced imaging modalities. Patients were recruited from various settings primary care, spine clinic, or emergency room.
In both trials, the proportion of patients who underwent lumbar radiography before enrollment was not reported. The most frequent methodological shortcoming was lack of or unclear use of blinded outcome assessment 5 of 6 trialsfollowed by inadequate description of randomization method 4 of 6 trials.
All trials excluded patients with features suggestive of a serious underlying condition, but exclusion criteria varied and trials did not indicate the number of patients excluded because of such factors. The authors found no significant difference between routine, immediate lumbar imaging and usual clinical care without immediate imaging for improvement in pain or function at short-term or long-term follow-up.
In the trial that reported extended 2-year follow-up data, immediate MRI or CT was not better than usual clinical care without immediate imaging on either the EuroQol-5D mean difference 0.
The authors concluded that lumbar imaging forLBP without indications of serious underlying conditions does not improve clinical outcomes and that clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute LBP and without features suggesting a serious underlying condition.
In a meta-analysis, Schoenfeld et al examined if adding an MRI would provide useful information that alters treatment when a CT scan reveals no evidence of injury in obtunded blunt trauma patients. Published studies from to involving patients undergoing MRI for the purposes of further cervical spine evaluation after a "negative" CT scan were identified via a literature search of online databases.
Data from eligible studies were pooled and original scale meta-analyses were performed to calculate overall sensitivity, specificity, positive and negative predictive values, likelihood ratios, and relative risk. The Q-statistic p value was used to evaluate heterogeneity. The Q-statistic p value for heterogeneity was 0.
The authors concluded that reliance on CT imaging alone to "clear the cervical spine" after blunt trauma can lead to missed injuries. The findings of this study supported the addition of MRI in evaluating patients who are obtunded, or unexaminable, despite a negative CT scan.
Callaghan et al examined diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care of patients with peripheral neuropathy. The to Health and Retirement Study Medicare claims-linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months.Magnetic Resonance Imaging and Computed Tomography (MRI/CT) The SIUC baccalaureate degree program in radiologic sciences is the .
Jan 27, · Magnetic resonance imaging (MRI) is generally thought to be better than computed tomography (CT) for the diagnosis of acute stroke, but this belief has never been substantiated for the full range of patients in whom this diagnosis is suspected. * Most students will finish the MRI Clinical Education by the end of August.
However, due to limited clinical placements, we reserve the right to extend this course to the end of the Fall Term. The program course sequence, as well as courses and dates are subject to change. Introduction: Options for imaging for evaluation of pediatric patients with unilateral sensorineural hearing loss (USNHL) include computed tomography (CT) and magnetic resonance imaging (MRI).Although both CT and MR imaging provide valuable information in the evaluation of pediatric patients with USNHL, debate remains regarding which imaging modality is most ideal and should be the preferred.
Nov 21, · Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan are among the radiology investigations that consume high amount of resources. However, the actual cost of these procedures has never been properly imputed before. Diagnostic imaging techniques help narrow the causes of an injury or illness and ensure that the diagnosis is accurate.
These techniques include x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI).