Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT
- 18 Downloads
To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast cervical spine CT.
A review of medical records identified all adult patients with blunt trauma who underwent CT cervical spine followed by MRI within 48 h over a 33-month period. Utility of subsequent MRI was assessed in terms of findings and impact on outcome.
A total of 1,271 patients with blunt cervical spine trauma underwent both cervical spine CT and MRI within 48 h; 1,080 patients were included in the study analysis. Sixty-six percent of patients with a CT cervical spine study had a negative study. Of these, the subsequent cervical spine MRI had positive findings in 20.9%; 92.6% had stable ligamentous or osseous injuries, 6.0% had unstable injuries and 1.3% had potentially unstable injuries. For unstable injury, the NPV for CT was 98.5%. In all 712 patients undergoing both CT and MRI, only 1.5% had unstable injuries, and only 0.42% had significant change in management.
MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain patients with persistent abnormal neurological examination.
• MRI has limited utility after negative cervical CT in blunt trauma.
• MRI is frequently positive for non-specific soft-tissue injury.
• Unstable injury missed on CT is infrequent.
KeywordsSpinal injuries Neck injuries Magnetic resonance imaging Wounds Nonpenetrating Soft tissue injuries
Anterior Longitudinal Ligament
Cervical spine injury
Glasgow Coma Scale
Institutional Review Board
Magnetic resonance imaging
Motor vehicle accident
National Emergency XRadiography Utilization Study
Negative predictive value
Posterior ligamentous complex
Posterior longitudnal ligament
Compliance with ethical standards
The scientific guarantor of this publication is Ajay Malhotra.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Institutional Review Board of Yale University approval was obtained for this study.
Written informed consent was waived by Institutional Review Board.
• case-control study
• performed at one institution
- 17.Gargas J, Yaszay B, Kruk P, Bastrom T, Shellington D, Khanna S (2013) An analysis of cervical spine magnetic resonance imaging findings after normal computed tomographic imaging findings in pediatric trauma patients: ten-year experience of a level I pediatric trauma center. J Trauma Acute Care Surg 74:1102–1107CrossRefPubMedGoogle Scholar
- 22.Patel MB, Humble SS, Cullinane DC et al (2015) Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 78:430–441CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Wu X, Malhotra A, Geng B et al (2017) Cost-effectiveness of magnetic resonance imaging in cervical spine clearance of neurologically intact patients with blunt trauma. Ann Emerg Med. https://doi.org/10.1016/j.annemergmed.2017.07.006
- 36.Fisher BM, Cowles S, Matulich JR, Evanson BG, Vega D, Dissanaike S (2013) Is magnetic resonance imaging in addition to a computed tomographic scan necessary to identify clinically significant cervical spine injuries in obtunded blunt trauma patients? Am J Surg 206:987–993 discussion 993-984CrossRefPubMedGoogle Scholar
- 38.Schoenfeld AJ, Tobert DG, Le HV et al (2017) The utility of adding magnetic resonance imaging to computed tomography alone in the evaluation of cervical spine injury: a propensity matched analysis. Spine (Phila Pa 1976). https://doi.org/10.1097/brs.0000000000002285