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Occult Lumbosacral Dysraphism in Children and Young Adults: Diagnostic Performance of Fast Screening and Conventional MR Imaging¹

¹ From the Department of Radiology, Health Services and Policy Section, Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45236 (L.S.M.), and the Department of Radiology, Harvard Medical School, Children's Hospital, Boston, Mass (M.A.O., D.Z., T.Y.P., J.D., P.D.B.). Received January 27, 1998; revision requested April 7; revision received September 11; accepted November 9. Address reprint requests to L.S.M.

PURPOSE: To compare fast screening and conventional magnetic resonance (MR) imaging for the detection of occult dysraphic myelodysplasias in children and young adults.

MATERIALS AND METHODS: A retrospective case-control study included 101 patients (mean age, 4.9 years; range, 1 day to 26 years) suspected of having occult lumbosacral dysraphism. Sixty case patients had myelodysplastic lesions (19 filar lipoma, 14 syringomyelia, 10 intradural lipoma, eight dermal sinus, five diastematomyelia, five lipomyelomeningocele, two caudal regression syndrome); 41 control patients had no dysraphic lesions; 17 patients had associated renal anomalies. Two neuroradiologists reviewed MR images from conventional and fast screening protocols. Diagnostic performance parameters included sensitivity, specificity, and area under the receiver operating characteristic curve (A_z value).

RESULTS: The sensitivity of conventional and fast screening MR studies was 97.1% and 98.5%, respectively; the specificity was 90.9% and 84.8%, respectively. The A_z value was 0.973 for the fast screening and 0.976 for the conventional MR studies (P = .83). Interobserver agreement was very good for fast screening images ( = 0.68) and excellent for conventional images ( = 0.75). For renal anomalies, the A_z value was 0.786 and 0.853 for fast screening and conventional MR imaging, respectively (P = .28).

CONCLUSION: Conventional three-plane lumbosacral MR imaging in children and young adults suspected of having occult dysraphism provides better diagnostic information than does fast screening two-plane MR imaging because of its higher specificity and interobserver agreement.

Index terms: Magnetic resonance (MR), in infants and children • Spinal cord, developmental defect, 33.145, 33.148, 33.361 • Spinal cord, MR, 33.121411 • Spinal cord, neoplasms, 33.361, 33.368, 33.369

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