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<meta name="DC.Title" content="Doing More with Less: Diagnostic Accuracy of CT in Suspected Cauda Equina Syndrome" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4974" />
<meta name="DC.Date" content="2017-02-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Cauda equina syndrome typically requires emergent MR imaging to detect compressive lesions on the cauda equina, which may require surgical decompression. While CT is sometimes performed as a complementary imaging technique to evaluate osseous integrity in patients with cauda equina syndrome, the accuracy of CT in detecting significant spinal stenosis and cauda equina impingement is not well-defined in the literature. We hypothesized that percentage thecal sac effacement on CT of the lumbar spine would have high sensitivity and high negative predictive value in evaluating significant spinal stenosis and cauda equina impingement.

MATERIALS AND METHODS: We analyzed imaging studies for 151 consecutive patients with clinically suspected cauda equina syndrome. The percentage thecal sac effacement (&lt;50%, ≥50%) was determined on CT and MR imaging. The presence or absence of cauda equina impingement was determined on MR imaging. Using MR imaging as the reference standard, we performed statistical analysis to determine the accuracy of CT in predicting significant spinal stenosis (percentage thecal sac effacement, ≥50%) and cauda equina impingement.

RESULTS: Forty of 151 patients had a percentage thecal sac effacement of ≥50% on MR imaging. Nineteen of 40 had cauda equina impingement. Readers determined that there was a CT percentage thecal sac effacement of &lt;50% in 97/151 cases, and CT percentage thecal sac effacement of ≥50% in 54/151 cases. Reader sensitivity for the detection of significant spinal stenosis (MR percentage thecal sac effacement of ≥50%) was 0.98; specificity, 0.86; positive predictive value, 0.72; and negative predictive value, 0.99. No cases read as CT percentage thecal sac effacement of &lt;50% were found to have cauda equina impingement.

CONCLUSIONS: CT percentage thecal sac effacement of ≥50% predicts significant spinal stenosis on MR imaging in patients with clinically suspected cauda equina syndrome. CT percentage thecal sac effacement of &lt;50% appears to reliably rule out cauda equina impingement. This imaging marker may serve as an additional tool for the clinician in deciding whether MR imaging can be deferred.

CEI
:   cauda equina impingement
CES
:   cauda equina syndrome
PTSE
:   percentage thecal sac effacement" />
<meta name="DC.Contributor" content="J.G. Peacock" />
<meta name="DC.Contributor" content="V.M. Timpone" />
<meta name="article:published_time" content="2017-02-01" />
<meta name="article:section" content="SPINE" />
<meta name="citation_title" content="Doing More with Less: Diagnostic Accuracy of CT in Suspected Cauda Equina Syndrome" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Cauda equina syndrome typically requires emergent MR imaging to detect compressive lesions on the cauda equina, which may require surgical decompression. While CT is sometimes performed as a complementary imaging technique to evaluate osseous integrity in patients with cauda equina syndrome, the accuracy of CT in detecting significant spinal stenosis and cauda equina impingement is not well-defined in the literature. We hypothesized that percentage thecal sac effacement on CT of the lumbar spine would have high sensitivity and high negative predictive value in evaluating significant spinal stenosis and cauda equina impingement.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We analyzed imaging studies for 151 consecutive patients with clinically suspected cauda equina syndrome. The percentage thecal sac effacement (&amp;lt;50%, ≥50%) was determined on CT and MR imaging. The presence or absence of cauda equina impingement was determined on MR imaging. Using MR imaging as the reference standard, we performed statistical analysis to determine the accuracy of CT in predicting significant spinal stenosis (percentage thecal sac effacement, ≥50%) and cauda equina impingement.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Forty of 151 patients had a percentage thecal sac effacement of ≥50% on MR imaging. Nineteen of 40 had cauda equina impingement. Readers determined that there was a CT percentage thecal sac effacement of &amp;lt;50% in 97/151 cases, and CT percentage thecal sac effacement of ≥50% in 54/151 cases. Reader sensitivity for the detection of significant spinal stenosis (MR percentage thecal sac effacement of ≥50%) was 0.98; specificity, 0.86; positive predictive value, 0.72; and negative predictive value, 0.99. No cases read as CT percentage thecal sac effacement of &amp;lt;50% were found to have cauda equina impingement.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;CT percentage thecal sac effacement of ≥50% predicts significant spinal stenosis on MR imaging in patients with clinically suspected cauda equina syndrome. CT percentage thecal sac effacement of &amp;lt;50% appears to reliably rule out cauda equina impingement. This imaging marker may serve as an additional tool for the clinician in deciding whether MR imaging can be deferred.&lt;/p&gt;" />
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<meta name="twitter:title" content="Doing More with Less: Diagnostic Accuracy of CT in Suspected Cauda Equina Syndrome" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Cauda equina syndrome typically requires emergent MR imaging to detect compressive lesions on the cauda equina, which may require surgical decompression. While CT is sometimes performed as a complementary imaging technique to evaluate osseous integrity in patients with cauda equina syndrome, the accuracy of CT in detecting significant spinal stenosis and cauda equina impingement is not well-defined in the literature. We hypothesized that percentage thecal sac effacement on CT of the lumbar spine would have high sensitivity and high negative predictive value in evaluating significant spinal stenosis and cauda equina impingement.

MATERIALS AND METHODS: We analyzed imaging studies for 151 consecutive patients with clinically suspected cauda equina syndrome. The percentage thecal sac effacement (&lt;50%, ≥50%) was determined on CT and MR imaging. The presence or absence of cauda equina impingement was determined on MR imaging. Using MR imaging as the reference standard, we performed statistical analysis to determine the accuracy of CT in predicting significant spinal stenosis (percentage thecal sac effacement, ≥50%) and cauda equina impingement.

RESULTS: Forty of 151 patients had a percentage thecal sac effacement of ≥50% on MR imaging. Nineteen of 40 had cauda equina impingement. Readers determined that there was a CT percentage thecal sac effacement of &lt;50% in 97/151 cases, and CT percentage thecal sac effacement of ≥50% in 54/151 cases. Reader sensitivity for the detection of significant spinal stenosis (MR percentage thecal sac effacement of ≥50%) was 0.98; specificity, 0.86; positive predictive value, 0.72; and negative predictive value, 0.99. No cases read as CT percentage thecal sac effacement of &lt;50% were found to have cauda equina impingement.

CONCLUSIONS: CT percentage thecal sac effacement of ≥50% predicts significant spinal stenosis on MR imaging in patients with clinically suspected cauda equina syndrome. CT percentage thecal sac effacement of &lt;50% appears to reliably rule out cauda equina impingement. This imaging marker may serve as an additional tool for the clinician in deciding whether MR imaging can be deferred.

CEI
:   cauda equina impingement
CES
:   cauda equina syndrome
PTSE
:   percentage thecal sac effacement" />
<meta name="og-title" property="og:title" content="Doing More with Less: Diagnostic Accuracy of CT in Suspected Cauda Equina Syndrome" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/38/2/391" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Cauda equina syndrome typically requires emergent MR imaging to detect compressive lesions on the cauda equina, which may require surgical decompression. While CT is sometimes performed as a complementary imaging technique to evaluate osseous integrity in patients with cauda equina syndrome, the accuracy of CT in detecting significant spinal stenosis and cauda equina impingement is not well-defined in the literature. We hypothesized that percentage thecal sac effacement on CT of the lumbar spine would have high sensitivity and high negative predictive value in evaluating significant spinal stenosis and cauda equina impingement.

MATERIALS AND METHODS: We analyzed imaging studies for 151 consecutive patients with clinically suspected cauda equina syndrome. The percentage thecal sac effacement (&lt;50%, ≥50%) was determined on CT and MR imaging. The presence or absence of cauda equina impingement was determined on MR imaging. Using MR imaging as the reference standard, we performed statistical analysis to determine the accuracy of CT in predicting significant spinal stenosis (percentage thecal sac effacement, ≥50%) and cauda equina impingement.

RESULTS: Forty of 151 patients had a percentage thecal sac effacement of ≥50% on MR imaging. Nineteen of 40 had cauda equina impingement. Readers determined that there was a CT percentage thecal sac effacement of &lt;50% in 97/151 cases, and CT percentage thecal sac effacement of ≥50% in 54/151 cases. Reader sensitivity for the detection of significant spinal stenosis (MR percentage thecal sac effacement of ≥50%) was 0.98; specificity, 0.86; positive predictive value, 0.72; and negative predictive value, 0.99. No cases read as CT percentage thecal sac effacement of &lt;50% were found to have cauda equina impingement.

CONCLUSIONS: CT percentage thecal sac effacement of ≥50% predicts significant spinal stenosis on MR imaging in patients with clinically suspected cauda equina syndrome. CT percentage thecal sac effacement of &lt;50% appears to reliably rule out cauda equina impingement. This imaging marker may serve as an additional tool for the clinician in deciding whether MR imaging can be deferred.

CEI
:   cauda equina impingement
CES
:   cauda equina syndrome
PTSE
:   percentage thecal sac effacement" />
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">391-397; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4974 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14651--61506101464" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.G. Peacock </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, San Antonio Military Medical Center, San Antonio, Texas.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.G.%2BPeacock%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Peacock%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.G.%2BPeacock%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1510-8367" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.G. Peacock</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">V.M. Timpone </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, San Antonio Military Medical Center, San Antonio, Texas.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.M.%2BTimpone%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Timpone%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AV.M.%2BTimpone%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-3519-846X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V.M. Timpone</a></li></ul></div></div></div>  </div>

  
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      <div class="highwire-cite-title">Doing More with Less: Diagnostic Accuracy of CT in Suspected Cauda Equina Syndrome</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.G.</span> <span class="nlm-surname">Peacock</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">V.M.</span> <span class="nlm-surname">Timpone</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">391-397; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4974 </span></div>
  
  
  
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      <div class="highwire-cite-title">Doing More with Less: Diagnostic Accuracy of CT in Suspected Cauda Equina Syndrome</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.G.</span> <span class="nlm-surname">Peacock</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">V.M.</span> <span class="nlm-surname">Timpone</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">391-397; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4974 </span></div>
  
  
  
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