However, in the absence of clinical evidence of neurologic or unstable ligament injury, MRI has a low probability of identifying a soft-tissue injury requiring surgical treatment that is not apparent on CT [40,41,43-48,55]. Recent prospective multicenter trials suggest that MRI has a role in evaluating patients who have a negative cervical spine CT. The Western Trauma Association Multi-Institutional trial reported that CT was effective for ruling out clinically significant injury with a sensitivity of 98.5%. A small but clinically significant incidence of a missed injury was noted, and further imaging with MRI is warranted [56]. The prospective ReCONECT trial studied 767 patients who had a negative cervical spine CT and went on to MRI because of cervicalgia (43.0%), inability to evaluate the cervical spine on physical examination (44.1%), or both (9.4%). MRI was abnormal in 23.6% of all patients, including ligamentous injury (16.6%), soft-tissue swelling (4.3%), vertebral disc injury (1.4%), and dural hematomas (1.3%). The patients with abnormal MRI were less likely to have their cervical collar removed than those with normal MRI (13.3% versus 88.1%). Eleven patients underwent cervical spine surgery after the MRI results. The clinical significance of these abnormal MRI findings could not be determined from this study group [55]. MRA Neck There is no role for MRA in the initial assessment of patients with suspected cervical spine injury. Arteriography Cervicocerebral There is no role for arteriography in the initial assessment of patients with suspected cervical spine injury. Variant 3: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Confirmed or suspected cervical spinal cord or nerve root injury, with or without traumatic injury identified on cervical CT. Next imaging study. Cervical spine CT is the preferred modality for the initial assessment of cervical spine injury.
Suspected Spine Trauma PCAs. However, in the absence of clinical evidence of neurologic or unstable ligament injury, MRI has a low probability of identifying a soft-tissue injury requiring surgical treatment that is not apparent on CT [40,41,43-48,55]. Recent prospective multicenter trials suggest that MRI has a role in evaluating patients who have a negative cervical spine CT. The Western Trauma Association Multi-Institutional trial reported that CT was effective for ruling out clinically significant injury with a sensitivity of 98.5%. A small but clinically significant incidence of a missed injury was noted, and further imaging with MRI is warranted [56]. The prospective ReCONECT trial studied 767 patients who had a negative cervical spine CT and went on to MRI because of cervicalgia (43.0%), inability to evaluate the cervical spine on physical examination (44.1%), or both (9.4%). MRI was abnormal in 23.6% of all patients, including ligamentous injury (16.6%), soft-tissue swelling (4.3%), vertebral disc injury (1.4%), and dural hematomas (1.3%). The patients with abnormal MRI were less likely to have their cervical collar removed than those with normal MRI (13.3% versus 88.1%). Eleven patients underwent cervical spine surgery after the MRI results. The clinical significance of these abnormal MRI findings could not be determined from this study group [55]. MRA Neck There is no role for MRA in the initial assessment of patients with suspected cervical spine injury. Arteriography Cervicocerebral There is no role for arteriography in the initial assessment of patients with suspected cervical spine injury. Variant 3: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Confirmed or suspected cervical spinal cord or nerve root injury, with or without traumatic injury identified on cervical CT. Next imaging study. Cervical spine CT is the preferred modality for the initial assessment of cervical spine injury.