The Influence and Effect of Magnetic Resonance Imaging on the Thoracolumbar Injury Classifica-tion and Evaluation

Abstract：Objective To evaluate the influence and effect of MRI in addition to CT on the thoracolubar injury classifica-tion and severity score. Methods A retrospective analysis of 80 patients with thoracolumbar injury patients from January 2010 to December 2013 was performed. All patients in this study had X-ray,CT and MRI scans. The number and level of fractures in patients were analyzed. According to TLICS system,the injury morphology were classified into compression,burst,translation/rotation,and distraction;the status of PLC were ranked with intact,suspected/ indeterminate,and injured. Neurological status and TLICS score was also assessed and calculated. The first evaluation was done with X-ray and CT data. Six weeks later,the second evaluation was performed while adding MRI data. The changes of rank of injury and TLICS score were evaluated with Wilcoxon rank sum test. Results CT test alone revealed 128 thoracolumbar fractures,23 new fractures were found with CT +MRI with a total of 151 fractures. The proportion of patients whose PLC assessment did not change using CT and MRI data to-gether amountedto0 . 79,with95 % WilsonCI( 0 . 67 ,0 . 88 ). Thechangedamountedto0 . 21 ,with95 % WilsonCI( 0 . 13 , 0. 31). The median TLICS using CT alone was 2. 1,whereas the median TLICS with CT and MRI together was 3. 5,Wilcoxon effect 4. 00,Wilcoxon P < 0. 001,with 95% Wilson CIs(3. 00,5. 00). In 56 out of 80 cases,the TLICS remained unchanged using CT and MRI together,but it changed in 24patients(30% ,upgraded 22 cases;downgraded 2 cases). The proportion of patients with a TLICS on CT < 5 and ≥ 5 on CT and MRI together amounted to 1 4( 0 . 1 8 ),with 9 5 % Wilson CIs( 0 . 1 0 , 0. 31). Conclusion The combination of CT and MRI can detect more bone and ligament injury than CT alone,and change the TLICS classification and score. Ligementous injures revealed by MRI were mainly responsible for these changes.