Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology

Introduction: A recent meta-analysis showed that only four prior studies have shown that magnetic resonance imaging (MRI) can change the fracture classification in 17% and treatment decisions in 22% of cases. However, previous studies showed a wide methodological variability regarding the study popu...

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Main Authors: Mohamed M. Aly, Sebastian F. Bigdon, Ulrich J.A. Speigl, Gaston Camino-Willhuber, Saleh Baeesa, Klaus J. Schnake
Format: Article
Language:English
Published: Elsevier 2024-01-01
Series:Brain and Spine
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Online Access:http://www.sciencedirect.com/science/article/pii/S2772529424000432
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author Mohamed M. Aly
Sebastian F. Bigdon
Ulrich J.A. Speigl
Gaston Camino-Willhuber
Saleh Baeesa
Klaus J. Schnake
author_facet Mohamed M. Aly
Sebastian F. Bigdon
Ulrich J.A. Speigl
Gaston Camino-Willhuber
Saleh Baeesa
Klaus J. Schnake
author_sort Mohamed M. Aly
collection DOAJ
description Introduction: A recent meta-analysis showed that only four prior studies have shown that magnetic resonance imaging (MRI) can change the fracture classification in 17% and treatment decisions in 22% of cases. However, previous studies showed a wide methodological variability regarding the study population, the definition of posterior ligamentous complex (PLC) injury, and outcome measures. Research question: How can we standardize the reporting of the impact of MRI for neurologically intact patients with thoracolumbar fractures? Material and methods: All available literature regarding the impact of MRI on thoracolumbar fracture classification or decision-making were reviewed. Estimating the impact of MRI on the TLFs' classification is an exercise of analyzing the CTs' accuracy for PLC injury against MRI as a ''Gold standard''and should follow standardized checklists such as the Standards for the Reporting of Diagnostic Accuracy Studies. Additionally, specific issues related to TLFs should be addressed. Results: A standardized approach for reporting the impact of MRI in neurologically intact TLF patients was proposed. Regarding patient selection, restricting the inclusion of neurologically intact patients with A- and B-injuries is crucial. Image interpretation should be standardized regarding imaging protocol and appropriate criteria for PLC injury. The impact of MRI can be measured by either the rate of change in fracture classification or treatment decisions; the cons and pros of each measure is thoroughly discussed. Discussion and conclusion: We proposed a structured methodology for examining the impact of MRI on neurologically intact patients with TLFs, focusing on appropriate patient selection, standardizing image analysis, and clinically relevant outcome measures.
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spelling doaj-art-0dca0b29f58c4f7e8c13ad18d208f92a2025-08-20T01:56:20ZengElsevierBrain and Spine2772-52942024-01-01410278710.1016/j.bas.2024.102787Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodologyMohamed M. Aly0Sebastian F. Bigdon1Ulrich J.A. Speigl2Gaston Camino-Willhuber3Saleh Baeesa4Klaus J. Schnake5Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia; Department of Neurosurgery, Mansoura University, Mansoura, Egypt; Corresponding author. Department of Neurosurgery, Prince Mohamed Ben Abdulaziz Hospital, P.O Box 54146, Riyadh, 11514, Saudi Arabia.Department of Orthopedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, SwitzerlandDepartment of Orthopedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, GermanyTraumatology Department, Asuncion Clinica, Basque Country, SpainKing Faisal Specialist Hospital and Research Center, Jeddah, Saudi ArabiaCenter for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany; Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, GermanyIntroduction: A recent meta-analysis showed that only four prior studies have shown that magnetic resonance imaging (MRI) can change the fracture classification in 17% and treatment decisions in 22% of cases. However, previous studies showed a wide methodological variability regarding the study population, the definition of posterior ligamentous complex (PLC) injury, and outcome measures. Research question: How can we standardize the reporting of the impact of MRI for neurologically intact patients with thoracolumbar fractures? Material and methods: All available literature regarding the impact of MRI on thoracolumbar fracture classification or decision-making were reviewed. Estimating the impact of MRI on the TLFs' classification is an exercise of analyzing the CTs' accuracy for PLC injury against MRI as a ''Gold standard''and should follow standardized checklists such as the Standards for the Reporting of Diagnostic Accuracy Studies. Additionally, specific issues related to TLFs should be addressed. Results: A standardized approach for reporting the impact of MRI in neurologically intact TLF patients was proposed. Regarding patient selection, restricting the inclusion of neurologically intact patients with A- and B-injuries is crucial. Image interpretation should be standardized regarding imaging protocol and appropriate criteria for PLC injury. The impact of MRI can be measured by either the rate of change in fracture classification or treatment decisions; the cons and pros of each measure is thoroughly discussed. Discussion and conclusion: We proposed a structured methodology for examining the impact of MRI on neurologically intact patients with TLFs, focusing on appropriate patient selection, standardizing image analysis, and clinically relevant outcome measures.http://www.sciencedirect.com/science/article/pii/S2772529424000432Magnetic resonance imagingThoracolumbar fractures, indicationsComputed tomographyDiagnostic accuracyNeurologically intactPosterior ligamentous complex
spellingShingle Mohamed M. Aly
Sebastian F. Bigdon
Ulrich J.A. Speigl
Gaston Camino-Willhuber
Saleh Baeesa
Klaus J. Schnake
Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology
Brain and Spine
Magnetic resonance imaging
Thoracolumbar fractures, indications
Computed tomography
Diagnostic accuracy
Neurologically intact
Posterior ligamentous complex
title Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology
title_full Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology
title_fullStr Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology
title_full_unstemmed Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology
title_short Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology
title_sort towards a standardized reporting of the impact of magnetic resonance imaging on the decision making of thoracolumbar fractures without neurological deficit conceptual framework and proposed methodology
topic Magnetic resonance imaging
Thoracolumbar fractures, indications
Computed tomography
Diagnostic accuracy
Neurologically intact
Posterior ligamentous complex
url http://www.sciencedirect.com/science/article/pii/S2772529424000432
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