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Is there added value in obtaining cervical spine MRI in the assessment of nontraumatic angiographically negative subarachnoid hemorrhage? A retrospective study and meta-analysis of the literature.
J Neurosurg. 2018 09; 129(3):670-676.JN

Abstract

OBJECTIVE Diagnostic algorithms for nontraumatic angiographically negative subarachnoid hemorrhage (AN-SAH) vary, and the optimal method remains subject to debate. This study assessed the added value of cervical spine MRI in identifying a cause for nontraumatic AN-SAH. METHODS Consecutive patients 18 years of age or older who presented with nontraumatic SAH between February 1, 2009, and October 31, 2014, with negative cerebrovascular catheter angiography and subsequent cervical MRI were studied. Patients with intraparenchymal, subdural, or epidural hemorrhage; recent trauma; or known vascular malformations were excluded. All cervical MR images were reviewed by two blinded neuroradiologists. The diagnostic yield of cervical MRI was calculated. A literature review was conducted to identify studies reporting the diagnostic yield of cervical MRI in patients with AN-SAH. The weighted pooled estimate of diagnostic yield of cervical MRI was calculated. RESULTS For all 240 patients (mean age 53 years, 48% male), catheter angiography was performed within 4 days after admission (median 12 hours, interquartile range [IQR] 10 hours). Cervical MRI was performed within 19 days of admission (median 24 hours, IQR 10 hours). In a single patient, cervical MRI identified a source for SAH (cervical vascular malformation). Meta-analysis of 7 studies comprising 538 patients with AN-SAH produced a pooled estimate of 1.3% (95% confidence interval 0.5%-2.5%) for diagnostic yield of cervical MRI. No statistically significant between-study heterogeneity or publication bias was identified. CONCLUSIONS Cervical MRI following AN-SAH, in the absence of findings to suggest spinal etiology, has a very low diagnostic yield and is not routinely necessary.

Authors+Show Affiliations

1Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.1Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.2Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia.3Department of Radiology, NYU School of Medicine, New York, New York; and.1Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia. 4Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29027857

Citation

Sadigh, Gelareh, et al. "Is There Added Value in Obtaining Cervical Spine MRI in the Assessment of Nontraumatic Angiographically Negative Subarachnoid Hemorrhage? a Retrospective Study and Meta-analysis of the Literature." Journal of Neurosurgery, vol. 129, no. 3, 2018, pp. 670-676.
Sadigh G, Holder CA, Switchenko JM, et al. Is there added value in obtaining cervical spine MRI in the assessment of nontraumatic angiographically negative subarachnoid hemorrhage? A retrospective study and meta-analysis of the literature. J Neurosurg. 2018;129(3):670-676.
Sadigh, G., Holder, C. A., Switchenko, J. M., Dehkharghani, S., & Allen, J. W. (2018). Is there added value in obtaining cervical spine MRI in the assessment of nontraumatic angiographically negative subarachnoid hemorrhage? A retrospective study and meta-analysis of the literature. Journal of Neurosurgery, 129(3), 670-676. https://doi.org/10.3171/2017.4.JNS163114
Sadigh G, et al. Is There Added Value in Obtaining Cervical Spine MRI in the Assessment of Nontraumatic Angiographically Negative Subarachnoid Hemorrhage? a Retrospective Study and Meta-analysis of the Literature. J Neurosurg. 2018;129(3):670-676. PubMed PMID: 29027857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is there added value in obtaining cervical spine MRI in the assessment of nontraumatic angiographically negative subarachnoid hemorrhage? A retrospective study and meta-analysis of the literature. AU - Sadigh,Gelareh, AU - Holder,Chad A, AU - Switchenko,Jeffrey M, AU - Dehkharghani,Seena, AU - Allen,Jason W, Y1 - 2017/10/13/ PY - 2017/10/14/pubmed PY - 2019/10/24/medline PY - 2017/10/14/entrez KW - AN = angiographically negative KW - CI = confidence interval KW - CTA = CT angiography KW - DSA = digital subtraction angiography KW - EMR = electronic medical record KW - FA = flip angle KW - IQR = interquartile range KW - QUADAS = Quality Assessment of Diagnostic Accuracy Studies KW - SAH = subarachnoid hemorrhage KW - added value KW - c-MRI = cervical MRI KW - cervical spine MRI KW - meta-analysis KW - nontraumatic angiographically negative subarachnoid hemorrhage KW - vascular disorders SP - 670 EP - 676 JF - Journal of neurosurgery JO - J Neurosurg VL - 129 IS - 3 N2 - OBJECTIVE Diagnostic algorithms for nontraumatic angiographically negative subarachnoid hemorrhage (AN-SAH) vary, and the optimal method remains subject to debate. This study assessed the added value of cervical spine MRI in identifying a cause for nontraumatic AN-SAH. METHODS Consecutive patients 18 years of age or older who presented with nontraumatic SAH between February 1, 2009, and October 31, 2014, with negative cerebrovascular catheter angiography and subsequent cervical MRI were studied. Patients with intraparenchymal, subdural, or epidural hemorrhage; recent trauma; or known vascular malformations were excluded. All cervical MR images were reviewed by two blinded neuroradiologists. The diagnostic yield of cervical MRI was calculated. A literature review was conducted to identify studies reporting the diagnostic yield of cervical MRI in patients with AN-SAH. The weighted pooled estimate of diagnostic yield of cervical MRI was calculated. RESULTS For all 240 patients (mean age 53 years, 48% male), catheter angiography was performed within 4 days after admission (median 12 hours, interquartile range [IQR] 10 hours). Cervical MRI was performed within 19 days of admission (median 24 hours, IQR 10 hours). In a single patient, cervical MRI identified a source for SAH (cervical vascular malformation). Meta-analysis of 7 studies comprising 538 patients with AN-SAH produced a pooled estimate of 1.3% (95% confidence interval 0.5%-2.5%) for diagnostic yield of cervical MRI. No statistically significant between-study heterogeneity or publication bias was identified. CONCLUSIONS Cervical MRI following AN-SAH, in the absence of findings to suggest spinal etiology, has a very low diagnostic yield and is not routinely necessary. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/29027857/Is_there_added_value_in_obtaining_cervical_spine_MRI_in_the_assessment_of_nontraumatic_angiographically_negative_subarachnoid_hemorrhage_A_retrospective_study_and_meta_analysis_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -