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European Radiology

, Volume 28, Issue 7, pp 2823–2829 | Cite as

Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT

  • Ajay Malhotra
  • David Durand
  • Xiao Wu
  • Bertie Geng
  • Khalid Abbed
  • Diego B. Nunez
  • Pina Sanelli
Magnetic Resonance

Abstract

Purpose

To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast cervical spine CT.

Methods

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.

Results

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.

Conclusions

MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain patients with persistent abnormal neurological examination.

Key Points

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.

Keywords

Spinal injuries Neck injuries Magnetic resonance imaging Wounds Nonpenetrating Soft tissue injuries 

Abbreviations

ALL

Anterior Longitudinal Ligament

CSI

Cervical spine injury

CT

Computed tomography

ED

Emergency department

GCS

Glasgow Coma Scale

IRB

Institutional Review Board

MRI

Magnetic resonance imaging

MVA

Motor vehicle accident

NEXUS

National Emergency XRadiography Utilization Study

NPV

Negative predictive value

PLC

Posterior ligamentous complex

PLL

Posterior longitudnal ligament

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

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.

Ethical approval

Institutional Review Board of Yale University approval was obtained for this study.

Informed consent

Written informed consent was waived by Institutional Review Board.

Methodology

• retrospective

• case-control study

• performed at one institution

Supplementary material

330_2017_5285_MOESM1_ESM.docx (40 kb)
ESM 1 (DOCX 40 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenUSA
  2. 2.Yale School of MedicineNew HavenUSA
  3. 3.Department of NeurosurgeryYale School of MedicineNew HavenUSA
  4. 4.Division Chief of Neuroradiology, Director Emergency Radiology, Brigham and Women’s and HospitalHarvard Medical SchoolBostonUSA
  5. 5.Department of Radiology Northwell HealthNew YorkUSA

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