title: Magnetic resonance imaging frequently changes classification of acute traumatic thoracolumbar spine injuries.
abstract: OBJECTIVE
  To evaluate the influence of additional (MRI) compared with computed tomography (CT) alone for the classification of traumatic spinal injuries using the Arbeitsgemeinshaft für Osteosynthesefragen (AO) system and the Thoraco-Lumbar Injury Classification and Severity (TLICS) scale.
  
  
  METHODS
  Images from 100 consecutive patients with at least one fracture on CT were evaluated retrospectively by three radiologists with regard to the AO and TLICS classification systems in 2 steps. First, all images from the initial CT examination were analyzed. Second, 6 weeks later, CT and MR images were analyzed together. Descriptive statistics and Wilcoxon tests were performed to identify changes in the number of fractures and ligamentous lesions detected and their corresponding classification.
  
  
  RESULTS
  CT and MRI together revealed a total of 196 fractures (CT alone 162 fractures). The AO classification changed in 31 %, the TLICS classification changed in 33 % of the patients compared with CT alone. Based on CT and MRI together, the TLICS value changed from values <5 (indication for conservative therapy) to values ≥ 5 (indication for surgical therapy) in 24 %.
  
  
  CONCLUSIONS
  MRI of patients with thoracolumbar spinal trauma considerably improved the detection of fractures and soft tissue injuries compared with CT alone and significantly changed the overall trauma classification.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Winklhofer
authors.forename: Merly
authors.initials: M
authors.lastname: Thekkumthala-Sommer
authors.forename: Diethard
authors.initials: D
authors.lastname: Schmidt
authors.forename: Kaspar
authors.initials: K
authors.lastname: Rufibach
authors.forename: Clément M L
authors.initials: CM
authors.lastname: Werner
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Jürg
authors.initials: J
authors.lastname: Hodler
authors.forename: Gustav
authors.initials: G
authors.lastname: Andreisek
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D013557:Switzerland / Q000453:epidemiology; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D055815:Young Adult