# Abnormalities on Spinal Magnetic Resonance Imaging in Children and Adolescents: A Two-Center Retrospective Cohort Study

## TL;DR

Spinal MRIs in children and adolescents often show abnormalities, but only a small percentage provide useful diagnostic information, suggesting the need for better criteria to guide MRI use.

## Contribution

This study identifies factors associated with clinically relevant spinal MRI findings in children and adolescents, emphasizing the need for clearer referral criteria.

## Key findings

- Only 19.2% of spinal MRIs in children and adolescents revealed clinically relevant abnormalities.
- Neurological abnormalities and shorter symptom duration are linked to more useful MRI findings.
- Most abnormalities were in the lumbar spine, with spondylolysis/spondylolisthesis and discopathy being common.

## Abstract

What are the main findings?

Only 19.2% of spinal MRIs in children and adolescents revealed clinically relevant abnormalities related to symptoms.Patients with neurological abnormalities, a shorter
symptom duration, or specific clinical indications other than chronic back pain were significantly more likely to have MRI findings that provided added
diagnostic value.

Only 19.2% of spinal MRIs in children and adolescents revealed clinically relevant abnormalities related to symptoms.

Patients with neurological abnormalities, a shorter
symptom duration, or specific clinical indications other than chronic back pain were significantly more likely to have MRI findings that provided added
diagnostic value.

What are the implications of the main findings?

Routine use of spinal MRI in children and adolescents for back pain or other clinical indications has limited diagnostic yield and should be carefully considered.Clear criteria are needed to guide MRI referral
in children and adolescents to reduce unnecessary imaging and healthcare costs.

Routine use of spinal MRI in children and adolescents for back pain or other clinical indications has limited diagnostic yield and should be carefully considered.

Clear criteria are needed to guide MRI referral
in children and adolescents to reduce unnecessary imaging and healthcare costs.

Background/Objectives: Magnetic Resonance Imaging (MRI) is frequently used to evaluate back pain and other spinal indications in the pediatric population. However, the diagnostic value in the pediatric population remains unclear. This study aimed to determine the prevalence of spinal abnormalities detected by MRI in children and adolescents and to identify factors associated with MRI findings of added diagnostic value. Methods: A retrospective two-centre cohort study was conducted among 229 patients aged 0–16 years who underwent spinal MRI at two hospitals. MRI findings were classified into five categories: (1) no finding; (2) spinal incidental finding; (3) confirmed diagnosis with no additional information; (4) confirmed diagnosis/severity with additional information; and (5) new diagnosis. In categories 4 and 5, there was an added value of the MRI scan. Patients with and without added MRI findings were compared regarding age, gender, presence of night pain, exercise-dependent pain, sharp pain localization, trauma, neurological abnormalities, and symptom duration. Results: The prevalence of MRI abnormalities related to the patient’s complaints was 19.2%. When the ‘added value of MRI’ group is compared to the ‘no added value of MRI group’, neurological abnormalities (p = 0.009) and shorter symptom duration (p = 0.002) were statistically associated with abnormal MRI findings. Stratified analysis showed that MRIs provided added diagnostic value more frequently in patients with clinical indications other than chronic back pain. Most abnormalities were located in the lumbar spine, with spondylolysis/spondylolisthesis and discopathy as the most common findings. Conclusions: Although spinal MRIs frequently detected abnormalities, only a small proportion of MRIs revealed findings that provided added diagnostic or therapeutic value. This highlights the importance of developing clear criteria for spinal MRI use in children and adolescents to minimize unnecessary imaging, limit patient burden, and optimize healthcare resources.