Lumbar MRI recommended over CT for diagnosing pediatric spondylolysis

Lumbar MRI is a high performer when it comes to presenting pediatric radiologists with images aimed at confirming or ruling out spondylolysis, a common cause of low back pain among young athletes.

As such, the non-radiative modality may be preferable to the current gold-standard, CT, for children and young adults presenting with possible damage to the pars portions of the lumbar spine.

That’s according to a meta-analysis of the literature by researchers at Geneva University Hospitals in Switzerland. Amira Dhouib, MD, and colleagues had their findings published online Sept. 23 in European Spine Journal.

The team systematically searched PubMed and Embase for all cases in which the accuracy of MRI was reported for the diagnosis of spondylolysis in young patients. Their search brought back 1,300 studies. Of these, four studies reflecting exams of 1,122 pars met their inclusion criteria.

Two reviewers independently assessed the methodological quality for each selected study, and the research team recalculated sensitivity and specificity for each of the four studies.

Their recalculation considered only direct visualization of a fracture line of the pars.

To estimate the diagnostic performance of the MRI, they generated a hierarchic summary receiver operating characteristic curve and tested heterogeneity.

The authors report that, on a per-pars basis, the pooled sensitivity and specificity of the MRI for the direct diagnosis of a pars defect were 81 percent (95 percent confidence interval) and 99 percent (95 percent confidence interval), respectively.

Further, they computed a high overall heterogeneity with respective high and low heterogeneity on sensitivity and specificity.

“Although the role of MRI in identifying edema/inflammation within the pars as an active lesion is proved, its ability to demonstrate and classify pars fracture line [as well as] CT is still controversial,” Dhouib et al. write. “This meta-analysis demonstrated a high diagnostic performance of MR imaging for the diagnosis of a pars defect in young adults. This technique may be considered as a first-line imaging technique as it helps to avoid exposure to ionizing radiation.”