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Comparison of standard, prone and cine MRI in the evaluation of tethered cord

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Abstract

Background

Tethered cord syndrome (TCS) is defined by abnormal traction on the spinal cord that confines its movement. Surgical cord release usually stops neurological deterioration; therefore, early and accurate neuroradiological diagnosis is important. Supine MRI is the imaging modality of choice, but prone MRI and cine MRI can demonstrate cord movement.

Objective

We compared the diagnostic accuracies of standard MRI, prone MRI and cine MRI in patients with clinical suspicion of TCS and evaluated inter-reader reliability for MR imaging.

Materials and methods

Children who underwent MRI for suspicion of TCS were retrospectively identified. Supine, prone and cine MRI studies were re-read by two pediatric neuroradiologists. Conus level, filum appearance and cord movement were documented.

Results

Thirteen of 49 children had tethered cord documented at surgery. Conus level had the highest diagnostic accuracy (sensitivity 69–77%, specificity 94%, positive predictive value 82–83%, negative predictive value 89–92%, correct diagnosis 88–90%) and highest between-reader concordance (98%). Prone and cine MRI did not add to the accuracy of the supine imaging.

Conclusion

Conus level provides the highest diagnostic accuracy and inter-reader reliability in TCS. Until a larger series is evaluated, it remains questionable whether prone or cine MRI provides enough additional diagnostic information to warrant routine use.

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Author notes

  1. John C. Egelhoff

    Present address: Department of Radiology, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA

Authors and Affiliations

  1. Department of Radiology, Cohen Children’s Medical Center, New Hyde Park, NY, USA

    Sukhjinder Singh

  2. Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3030, USA

    Beth Kline-Fath, Judy M. Racadio & John C. Egelhoff

  3. Department of Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Karin Bierbrauer

  4. Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Shelia Salisbury & Maurizio Macaluso

  5. Department of Pediatrics, Division of Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Elizabeth C. Jackson

Authors
  1. Sukhjinder Singh
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  2. Beth Kline-Fath
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  3. Karin Bierbrauer
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  4. Judy M. Racadio
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  5. Shelia Salisbury
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  6. Maurizio Macaluso
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  7. Elizabeth C. Jackson
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  8. John C. Egelhoff
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Corresponding author

Correspondence to John C. Egelhoff.

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Singh, S., Kline-Fath, B., Bierbrauer, K. et al. Comparison of standard, prone and cine MRI in the evaluation of tethered cord. Pediatr Radiol 42, 685–691 (2012). https://doi.org/10.1007/s00247-011-2308-8

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  • DOI: https://doi.org/10.1007/s00247-011-2308-8

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