A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management.
Authors
Nouri, Aria
Scoffings, Daniel J
Mannion, Richard J
Trivedi, Rikin
Timofeev, Ivan
Crawford, John R
Hay, Douglas
Publication Date
2019-01Journal Title
PloS one
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Volume
14
Issue
7
Pages
e0219380
Language
eng
Type
Article
This Version
VoR
Physical Medium
Electronic-eCollection
Metadata
Show full item recordCitation
Tempest-Mitchell, J., Hilton, B., Davies, B., Nouri, A., Hutchinson, P., Scoffings, D. J., Mannion, R. J., et al. (2019). A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management.. PloS one, 14 (7), e0219380. https://doi.org/10.1371/journal.pone.0219380
Abstract
INTRODUCTION
Magnetic resonance imaging (MRI) is gold-standard for investigating Degenerative Cervical Myelopathy (DCM), a disabling disease triggered by compression of the spinal cord following degenerative changes of adjacent structures. Quantifiable compression correlates poorly with disease and language describing compression in radiological reports is un-standardised.
STUDY DESIGN
Retrospective chart review.
OBJECTIVES
1) Identify terminology in radiological reporting of cord compression and elucidate relationships between language and quantitative measures 2) Evaluate language’s ability to distinguish myelopathic from asymptomatic compression 3) Explore correlations between quantitative or qualitative features and symptom severity 4) Investigate the influence of quantitative and qualitative measures on surgical referrals.
METHODS
From all cervical spine MRIs conducted during one year at a tertiary centre (N = 1123), 166 patients had reported cord compression. For each spinal level deemed compressed by radiologists (N = 218), four quantitative measurements were calculated: ‘Maximum Canal Compromise (MCC); ‘Maximum Spinal Cord Compression’ (MSCC); ‘Spinal Canal Occupation Ratio’ (SCOR) and ‘Compression Ratio’ (CR). These were compared to associated radiological reporting terminology.
RESULTS
1) Terminology in radiological reports was varied. Objective measures of compromise correlated poorly with language. “Compressed” was used for more severe cord compromise as measured by MCC (p<0.001), MSCC (p<0.001), and CR (p = 0.002).
2) Greater compromise was seen in cords with a myelopathy diagnosis across MCC (p<0.001); MSCC (p = 0.002) and CR (p<0.001). “Compress” (p<0.001) and “Flatten” (p<0.001) were used more commonly for myelopathy-diagnosis levels.
3) Measurements of cord compromise (MCC: p = 0.304; MSCC: p = 0.217; SCOR: p = 0.503; CR: p = 0.256) and descriptive terms (p = 0.591) did not correlate with i-mJOA score.
4) The only variables affecting spinal surgery referral were increased MSCC (p = 0.001) and use of ‘Compressed’ (p = 0.045).
CONCLUSIONS
Radiological reporting in DCM is variable and language is not fully predictive of the degree of quantitative cord compression. Additionally, terminology may influence surgical referrals.
Keywords
Cervical Vertebrae, Humans, Spinal Cord Compression, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Young Adult
Sponsorship
Welcome Trust
NIHR
Funder references
Department of Health (via National Institute for Health Research (NIHR)) (CS-2015-15-023)
MRC (MC_PC_12009)
Embargo Lift Date
2100-01-01
Identifiers
External DOI: https://doi.org/10.1371/journal.pone.0219380
This record's URL: https://www.repository.cam.ac.uk/handle/1810/294118