title: Is radiation-free diagnostic monitoring of adolescent idiopathic scoliosis feasible using upright positional magnetic resonance imaging?
abstract: METHODS
  Prospective clinical trial.
  
  
  OBJECTIVE
  The purpose of this study was to determine if an upright positional magnetic resonance imaging (MRI) protocol could produce reliable spinal curvature images and measurements compared with traditional radiograph.
  
  
  BACKGROUND
  Concerns about the oncological potential from cumulative doses of ionizing radiation in children and adolescents being monitored for adolescent idiopathic scoliosis (AIS) initiated a search for radiation-free diagnostic imaging modalities, including MRI. We submit that upright, positional MRI (uMRI) produces reliable spinal curvature images compared with traditional radiograph.
  
  
  METHODS
  Twenty-five consecutive patients (16 female; 9 male; average age, 14.6 yr; range, 12-18 yr) with a diagnosis of AIS were enrolled. Average major curve magnitude was 30° (range, 6°-70°). Subjects received anterior-posterior and lateral plain radiographical scoliosis imaging followed within 1 week by uMRI. MRI data acquisition was performed in less than 7 minutes. Two independent observers performed all Cobb angle, T5-T12 kyphosis, and vertebral rotation measurements for comparison. The Pearson correlation method was performed to compare radiograph to uMRI measurements, while inter-rater and intrarater correlations were performed to assess reliability.
  
  
  RESULTS
  We found outstanding correlation between all plain film radiography and uMRI measurements (P = 0.01); major Cobb angles (R = 0.901), minor Cobb angles (R = 0.838), and kyphosis (R = 0.943). Inter-rater reliability for both radiographical and MRI measurements of major Cobb angles (R = 0.959, 0.896, respectively), minor Cobb angles (R = 0.951, 0.857, respectively), and vertebral rotation (R = 0.945) were outstanding. Intrarater reliability for both radiographical and MRI measurements of major Cobb angles (R = 0.966, 0.966, respectively) and minor Cobb angles (R = 0.945, 0.943, respectively) were also outstanding.
  
  
  CONCLUSIONS
  Our results show that uMRI is capable of producing coronal and sagittal plane measurements that highly correlate with traditional plain film radiographical measurements. This, in addition to reliable vertebral rotation measurements, makes uMRI a valuable, radiation-free alternative/substitute for diagnostic evaluation in AIS.
authors: Department of Orthopedic Surgery, New York University-Hospital for Joint Diseases, New York, NY, USA.
authors: Christopher
authors: C
authors: Diefenbach
authors: Baron S
authors: BS
authors: Lonner
authors: Joshua D
authors: JD
authors: Auerbach
authors: Neil
authors: N
authors: Bharucha
authors: Laura E
authors: LE
authors: Dean
mesh_terms: D000293:Adolescent; D000886:Anthropometry / Q000379:methods*; D002648:Child; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D011187:Posture; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D012399:Rotation; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000473:pathology*; D012680:Sensitivity and Specificity