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CT
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Usually not requiring sedation
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Poor delineation of neural structures
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Only study method for which there are diagnosis-specific standards (FM size) [122]
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Substantial radiation exposure, particularly if not performed in children’s facility
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Only study method for which prospective assessment of value in ascertaining risk is available [8]
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In substantial minority, along with results of other non-radiologic studies, will lead to MRI subsequently
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In our experience, about 20% of those following protocol including CT will go on to MRI
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MRI
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Excellent delineation of neural structures
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Virtually always requires sedation or anesthesia
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Because of respiratory concerns present in most infants with achondroplasia, anesthesia is usually needed
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No radiation exposure
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No diagnosis-specific standards
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Substantial risk of over-reliance in determining if surgery is needed
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Although not prevalent in our center, there are many anecdotes of electing to have decompressive surgery based on MRI craniocervical features alone, which we would judge to be non-actionable without other indications
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Fast MRI
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Fair delineation of neural structures
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Detail may be insufficient for decision making
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No radiation exposure
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No diagnosis-specific standards
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No sedation or anesthesia needed
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In substantial minority will lead to full MRI before deciding if surgery is needed
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At current level of detail, findings on fast MRI will always need to be confirmed by routine MRI if surgery is contemplated
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No routine imaging
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No sedation or anesthesia
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Under-ascertainment of those needing decompression
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This is, in my opinion, an unacceptable risk
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No radiation exposure
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Ignores what prospective and reasonably well controlled trial data as are available to prevent further neurologic injury or sudden death.
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