Assessment of IV Contrast Utilization and Utility in the MRI Evaluation of Acute Spine Trauma

Purpose: MRI is a valuable tool in evaluating select acute spine trauma cases, offering superior assessment of soft tissue, ligament, and spinal cord injuries compared to CT and radiographs. Although the ACR Appropriateness Criteria advises MRIs be performed without gadolinium-based IV contrast, guidelines utilized by ordering physicians do not clarify the role of contrast. The downsides of IV contrast should be balanced against potential benefits. This study examined the frequency and value of contrast-enhanced MRI in acute spine trauma. Methods: An IRB-approved retrospective chart review of spine MRIs ordered for trauma between 2020 and 2022 was conducted at a level 1 trauma, academic medical center. Contrast-enhanced studies were reviewed by a neuroradiologist for clinically significant findings (fractures, ligamentous injuries, epidural hematoma, cord injury) visible only or more clearly on postcontrast imaging. Patient demographics, clinical and operative notes, ordering provider specialty, and preceding imaging were reviewed. Results: Of 729 eligible patients receiving MRIs (608 adult, 121 pediatric), 16.2% of studies were performed with contrast. Pediatric patients were more likely to have radiographs and less likely to have CTs performed before MRI. Pediatric patients were more likely to undergo contrast-enhanced MRIs than adults (32.2% vs. 13.0%). Hospitalists ordered contrast more frequently (61.5%) than surgery (14.2%), emergency medicine (12.6%), or internal medicine (21.2%) providers. No cases were identified where postcontrast imaging provided findings missed or less visible on precontrast imaging. Conclusions: The absence of added value from contrast-enhanced imaging supports ACR guidelines against routine contrast use in MRI assessment of spine trauma. Heterogeneous ordering practices highlight the need for provider education.