Is the Atlantoaxial Level Overlooked in the Radiologic Interpretation of Cervical Magnetic Resonance Imaging?

Abstract

Study design: Retrospective analysis.

Objective: The purpose of this study is to quantify the rate at which the atlantoaxial level is omitted from official cervical magnetic resonance imaging (MRI) radiologic reports and to identify potential missed pathology, emphasizing the need for improved standardization of evaluation.

Summary of background data: MRI is a readily utilized modality for evaluating the axial skeleton. In our experience, the atlantoaxial level of the cervical spine is often overlooked on MRI radiologic reports in the absence of trauma or obvious pathology.

Methods: The preoperative MRIs and associated radiologic reports of 219 patients undergoing cervical decompression and fusion in a single year were collected. The inclusion or omission of distinct evaluation at the atlantoaxial level within each radiologic report was recorded. All imaging was then reviewed. The atlantoaxial level was specifically evaluated, and any pathology was noted and compared with the official radiologic reports. The rates of atlantoaxial evaluation omission from the radiologic reports and missed pathology at this level were primarily and secondarily reported.

Results: MRI studies were performed at 101 different institutions, with reports issued by 126 individual radiologists. Specific documentation of atlantoaxial evaluation was noted in 32 (14.6%) radiology reports, with the remaining 187 cases (85.4%) including no mention of this level. Upon independent re-review of the imaging, pathology was noted at the atlantoaxial level in 18 patients (8.2%), totaling 19 abnormal findings. Such findings were absent from the official reports in 13 of these cases (5.9% of the total study population).

Conclusions: In our study, formal documentation was omitted from 85% of reports resulting in missed pathology in nearly 6% of cases. This study underscores the importance of thorough imaging interpretation and clinical correlation with patient symptoms. In addition, it highlights the need for standardized reporting of these studies to prevent potential morbidity associated with a missed diagnosis.