MRI has the added benefit of identifying additional soft-tissue injuries frequently associated with cervical spine instability, such as epidural hematoma and cord contusion, which also may necessitate surgical management. Suspected Spine Trauma However, there are no widely accepted criteria for grading the severity of cervical spine soft-tissue injury on MRI, and while MRI has been shown to have high sensitivity for identifying soft-tissue injuries of the cervical spine, the specificity of MRI for identifying clinically significant cervical soft-tissue injuries is only modest. In a 2015 study by Zhuge et al [62], MRI demonstrated 100% sensitivity for diagnosis of injury to the cervical paraspinal muscles, intervertebral disc, and interspinous ligament but with specificities of only 77%, 71%, and 64% for these structures, respectively. Therefore, care should be taken in interpretation of soft-tissue injuries identified on MRI. Variant 5: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical or imaging findings suggest arterial injury with or without positive cervical spine CT. Next imaging study. Arterial injury can be a concern in blunt and penetrating spinal injury. An estimated 1% to 3% of blunt trauma patients are diagnosed with cerebrovascular transection, pseudoaneurysm formation, and simple dissection. Dissections and pseudoaneurysms may or may not produce stenosis and flow limitation of the affected artery. The presence of dissection in itself is generally taken to represent a risk of thrombus formation and subsequent embolization. Many different head and neck injury patterns and clinical symptoms have been associated with blunt cerebrovascular injuries (BCVIs) [52,53,63-68]. Up to two-thirds of patients with BCVIs may be asymptomatic at presentation [65] and not develop stroke-like symptoms for 48 to 72 hours after initial blunt trauma injury [63,64].
Suspected Spine Trauma PCAs. MRI has the added benefit of identifying additional soft-tissue injuries frequently associated with cervical spine instability, such as epidural hematoma and cord contusion, which also may necessitate surgical management. Suspected Spine Trauma However, there are no widely accepted criteria for grading the severity of cervical spine soft-tissue injury on MRI, and while MRI has been shown to have high sensitivity for identifying soft-tissue injuries of the cervical spine, the specificity of MRI for identifying clinically significant cervical soft-tissue injuries is only modest. In a 2015 study by Zhuge et al [62], MRI demonstrated 100% sensitivity for diagnosis of injury to the cervical paraspinal muscles, intervertebral disc, and interspinous ligament but with specificities of only 77%, 71%, and 64% for these structures, respectively. Therefore, care should be taken in interpretation of soft-tissue injuries identified on MRI. Variant 5: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical or imaging findings suggest arterial injury with or without positive cervical spine CT. Next imaging study. Arterial injury can be a concern in blunt and penetrating spinal injury. An estimated 1% to 3% of blunt trauma patients are diagnosed with cerebrovascular transection, pseudoaneurysm formation, and simple dissection. Dissections and pseudoaneurysms may or may not produce stenosis and flow limitation of the affected artery. The presence of dissection in itself is generally taken to represent a risk of thrombus formation and subsequent embolization. Many different head and neck injury patterns and clinical symptoms have been associated with blunt cerebrovascular injuries (BCVIs) [52,53,63-68]. Up to two-thirds of patients with BCVIs may be asymptomatic at presentation [65] and not develop stroke-like symptoms for 48 to 72 hours after initial blunt trauma injury [63,64].