MRI Cervical Spine MRI of cervical spine may be of value as a follow-up examination in patients who have an abnormal neurological examination. MRI without IV contrast is considered the reference standard for evaluation of soft tissues [48,56], although one study showed that MRI detected osseous injury in children with a sensitivity of 100% and a specificity of 97% [48]. MRI was shown to be superior to CT and radiographs in children with craniocervical junction injuries to ligaments and the spinal cord, including soft-tissue injuries that are best seen on fat-saturated T2 sequences [51]. It was shown in adults that while MRI has high sensitivity for soft-tissue injury, its lack of specificity makes it less suitable for operative decision making [45]. MRI is the modality of choice in children who fulfill criteria for myelopathy or SCIWORA [51,57-59]. It has been shown in children and adults that MRI following a completed cervical CT did not add any clinically significant information [7,60-64]. Some reports stated that adult cervical injuries were detected with MRI and not with CT and that these changed management [65,66]. A study of 45 patients showed that children with normal radiography and CT may have signs of traumatic cervical injury on MRI [51]. However, a recent meta-analysis showed that the pooled incidence of unstable injuries detected by MRI but missed on CT was 0.0029% [67]. MRI can identify vascular intramural hematomas and early ischemic spinal cord injuries and thus identify patients who may benefit from additional vascular imaging and management of ischemic complications [68]. Disadvantages include lengthy examination times in an environment where patient monitoring can be difficult. The requirement for a motion-free examination and the need for optimal positioning in children may lengthen examination times or require sedation.
Suspected Spine Trauma Child PCAs. MRI Cervical Spine MRI of cervical spine may be of value as a follow-up examination in patients who have an abnormal neurological examination. MRI without IV contrast is considered the reference standard for evaluation of soft tissues [48,56], although one study showed that MRI detected osseous injury in children with a sensitivity of 100% and a specificity of 97% [48]. MRI was shown to be superior to CT and radiographs in children with craniocervical junction injuries to ligaments and the spinal cord, including soft-tissue injuries that are best seen on fat-saturated T2 sequences [51]. It was shown in adults that while MRI has high sensitivity for soft-tissue injury, its lack of specificity makes it less suitable for operative decision making [45]. MRI is the modality of choice in children who fulfill criteria for myelopathy or SCIWORA [51,57-59]. It has been shown in children and adults that MRI following a completed cervical CT did not add any clinically significant information [7,60-64]. Some reports stated that adult cervical injuries were detected with MRI and not with CT and that these changed management [65,66]. A study of 45 patients showed that children with normal radiography and CT may have signs of traumatic cervical injury on MRI [51]. However, a recent meta-analysis showed that the pooled incidence of unstable injuries detected by MRI but missed on CT was 0.0029% [67]. MRI can identify vascular intramural hematomas and early ischemic spinal cord injuries and thus identify patients who may benefit from additional vascular imaging and management of ischemic complications [68]. Disadvantages include lengthy examination times in an environment where patient monitoring can be difficult. The requirement for a motion-free examination and the need for optimal positioning in children may lengthen examination times or require sedation.