Urgent MRI: when, what, and why—a single Italian center experience

Abstract Purpose The aim of our study is to provide a list of clinical situations that might justify the performance of an urgent MRI (uMRI) based on clinical relevance, correlating the MRI findings with the clinical indications and the urgent management of patients. Methods We reviewed all uMRI scans of brain (buMRI) and spine (suMRI) performed in our Department from August 2020 to February 2024. We analyzed the main clinical indications, the neuroradiological findings, and the relevance of these results in the therapeutic decisions. Results The main indication for buMRI was the evaluation of ischemic stroke detected at preliminary CT scan followed by coma, status epilepticus, suspected acute inflammatory diseases, trauma, suspicious of infective diseases, and pre-surgical evaluation of cerebral tumors. The main findings were: ischemia, acute inflammatory conditions, post-traumatic and post-ictal alterations, venous thrombosis, infective diseases, and cerebral tumors. 65% of patients underwent an urgent therapeutic intervention. The main indications for suMRI were clinical suspicion of myelopathy and radiculopathy including cauda equina syndrome secondary to trauma, neoplasms, inflammatory and infective diseases, degenerative changes, surgery, and vascular diseases. The main findings were: post-traumatic, degenerative and neoplastic myelopathy or radiculopathy, inflammatory and infective changes of the spinal cord, post-surgical fluid collections, and vascular diseases. About 77% of suMRI was followed by an urgent surgery. Conclusions Our study showed an overall good correlation between buMRI-suMRI findings and the clinical indications for the examinations. Also, uMRI affected the urgent management in a good percentage of patients, proving the significance of uMRI findings.