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Eur Radiol. 2017 Mar;27(3):1148-1160. doi: 10.1007/s00330-016-4426-z. Epub 2016 Jun 22.

Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis.

Author information

1
Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA. ajay.malhotra@yale.edu.
2
Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA.
3
Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA.
4
Minimally Invasive Spine Surgery & Spine Tumor Surgery, Yale School of Medicine, New Haven, CT, USA.

Abstract

OBJECTIVES:

To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance.

METHODS:

We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference. Variables assessed included severity, CT/MRI specifications, imaging timing, and outcome/follow-up. Pooled incidences of unstable injury on follow-up weighted by inverse-of-variance among all included and obtunded or alert patients were reported.

RESULTS:

Of 428 unique citations, 23 proved eligible, with 5,286 patients found, and 16 unstable injuries reported in five studies. The overall pooled incidence is 0.0029 %. Among studies reporting only obtunded patients, the pooled incidence is 0.017 %. In alert patients, the incidence is 0.011 %. All reported positive findings were critically reviewed, and only 11 could be considered truly unstable.

CONCLUSIONS:

There is significant heterogeneity in the literature regarding the use of imaging after a negative CT. The finding rate on MRI for unstable injury is extremely low in obtunded and alert patients. Although MRI is frequently performed, its utility and cost-effectiveness needs further study.

KEY POINTS:

• There were 16 unstable injuries on follow-up MRI among 5286 patients. • The positive finding rate among obtunded patients was 0.12 %. • The positive finding rate among alert, awake patients was 0.72 %. • MRI has a high false-positive rate; its utility mandates further studies. • The use and role of "confirmatory" tests shows wide variations.

KEYWORDS:

CT; Cervical spine trauma; Ligamentous/soft tissue injury; MRI; Meta-analysis

PMID:
27334017
DOI:
10.1007/s00330-016-4426-z
[Indexed for MEDLINE]
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