MRI Cervical Spine MRI is generally considered inferior to CT in identifying fractures. MRI is superior to CT in identifying soft- tissue injuries of the cervical spine [37-42]. Trauma patients with negative cervical spine CT will have traumatic soft-tissue injuries identified on MRI in 5% to 24% of cases [39-41,44,45,47,48]. The identification of these soft- tissue injuries often results in extended placement of a cervical collar. However, in the absence of clinical evidence of neurologic or unstable ligament injury, MRI has a very 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 Research Consortium of New England Centers for Trauma (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 MR angiography (MRA) in the initial assessment of patients with low risk for cervical spine injury.
Suspected Spine Trauma PCAs. MRI Cervical Spine MRI is generally considered inferior to CT in identifying fractures. MRI is superior to CT in identifying soft- tissue injuries of the cervical spine [37-42]. Trauma patients with negative cervical spine CT will have traumatic soft-tissue injuries identified on MRI in 5% to 24% of cases [39-41,44,45,47,48]. The identification of these soft- tissue injuries often results in extended placement of a cervical collar. However, in the absence of clinical evidence of neurologic or unstable ligament injury, MRI has a very 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 Research Consortium of New England Centers for Trauma (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 MR angiography (MRA) in the initial assessment of patients with low risk for cervical spine injury.