The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis
Rattachement africain : us, ec, gb, jp, nl, ca. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
The clinical indications and added value of obtaining MRI in the acute phase of spinal cord injury (SCI) remain controversial. This review aims to critically evaluate evidence regarding the role of MRI to influence decision-making and outcomes in acute SCI. A systematic review and meta-analysis were performed according to PRISMA methodology to identify studies that address six key questions (KQs) regarding diagnostic accuracy, frequency of abnormal findings, frequency of altered decision-making, optimal timing, and differences in outcomes related to obtaining an MRI in acute SCI. A total of 32 studies were identified that addressed one or more KQs. MRI showed no adverse events in 156 patients (five studies) and frequently identified cord compression (70%, 12 studies), disc herniation (43%, 16 studies), ligamentous injury (39%, 13 studies), and epidural hematoma (10%, two studies), with good diagnostic accuracy (seven comparative studies) except for fracture detection. MRI findings often altered management, including timing of surgery (78%, three studies), decision to operate (36%, 15 studies), and surgical approach (29%, nine studies). MRI may also be useful to determine the need for instrumentation (100%, one study), which levels to decompress (100%, one study), and if reoperation is needed (34%, two studies). The available literature consistently concluded that MRI was useful prior to surgical treatment (13 studies) and after surgery to assess decompression (two studies), but utility before/after closed reduction of cervical dislocations was unclear (three studies). One study showed improved outcomes with an MRI-based protocol but had a high risk of bias. Heterogeneity was high for most findings (I2 > 0.75). MRI is safe and frequently identifies findings alter clinical management in acute SCI, although direct evidence of its impact on outcomes is lacking. MRI should be performed before and after surgery, when feasible, to facilitate improved clinical decision-making. However, further research is needed to determine its optimal timing, effect on outcomes, cost-effectiveness, and utility before and after closed reduction.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis
- Date Crossref
- 26/10/2021
- Éditeur
- MDPI AG
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Hawaiʻi at Mānoa pays non établi dans la noticeUniversité ou école supérieure
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Neurological Surgery pays non établi dans la noticeÉtablissement de santé
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University of California Department of Neurological Surgery pays non établi dans la noticeUniversité ou école supérieure
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Universidad Internacional del Ecuador pays non établi dans la noticeUniversité ou école supérieure
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National Hospital for Neurology and Neurosurgery pays non établi dans la noticeÉtablissement de santé
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UCL Queen Square Institute of Neurology pays non établi dans la noticeUniversité ou école supérieure
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University College London Queen Square Institute of Neurology pays non établi dans la noticeUniversité ou école supérieure
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Kōchi University Department of Orthopaedic Surgery pays non établi dans la noticeUniversité ou école supérieure
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University Medical Center Groningen pays non établi dans la noticeÉtablissement de santé
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Medical College of Wisconsin Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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University of Toronto Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Toronto Western Hospital pays non établi dans la noticeÉtablissement de santé
University of Hawaiʻi at Mānoa, Neurological Surgery et Department of Neurological Surgery — University of California, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.