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Eur Radiol. 2018 Jul;28(7):2823-2829. doi: 10.1007/s00330-017-5285-y. Epub 2018 Feb 15.

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

Author information

1
Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA. ajay.malhotra@yale.edu.
2
Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA.
3
Yale School of Medicine, New Haven, CT, USA.
4
Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.
5
Division Chief of Neuroradiology, Director Emergency Radiology, Brigham and Women's and Hospital, Harvard Medical School, Boston, MA, USA.
6
Department of Radiology Northwell Health, New York, NY, USA.

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:

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

PMID:
29450715
DOI:
10.1007/s00330-017-5285-y
[Indexed for MEDLINE]

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