In the setting of persistent neck pain after cervical trauma, MRI may be useful for identifying ligament sprains, muscle strains, disc herniation, and bone bruising, which are the most likely causes of persistent pain. However, MRI has a tendency to overestimate the severity of ligament and other soft-tissue injuries with specificity rates reported as low as 64% to 77% for soft-tissue injury and a reported false-positive rate of 25% to 40% [42,62]. Soft-tissue edema and signal changes are often slow to resolve, persisting well after the patient has become asymptomatic. Conversely, subacute to chronic soft-tissue injuries can be difficult to appreciate once soft-tissue edema has subsided, and it is often challenging to determine integrity of scarred ligaments. For these reasons, flexion- extension radiographs may be complementary to MRI, and performed flexion-extension radiographs may better determine cervical instability in the setting of subacute or chronic cervical spine injury. Much research has been performed in an attempt to identify MRI findings that can be used to diagnose or help provide a prognosis for WAD [85,86,88,89,91-97,102,103]. These studies have primarily focused on signal changes within the craniocervical (alar and transverse) ligaments, atrophy of the paraspinal muscles, and progression of cervical degenerative changes as indicators of WAD. Associations between MRI findings and WAD are weak at best [86,87], and most studies have found no difference in MRI findings between WAD patients and non-WAD patients [85,92,94-97,103] and no correlation between MRI findings and WAD symptoms or progression [88,89]. MRA Neck There is no role for MRA in the assessment of patients with persistent pain on follow-up visit with cervical collar in place. Suspected Spine Trauma Arteriography Cervicocerebral There is no role for arteriography in the assessment of patients with persistent pain on follow-up visit with cervical collar in place.
Suspected Spine Trauma PCAs. In the setting of persistent neck pain after cervical trauma, MRI may be useful for identifying ligament sprains, muscle strains, disc herniation, and bone bruising, which are the most likely causes of persistent pain. However, MRI has a tendency to overestimate the severity of ligament and other soft-tissue injuries with specificity rates reported as low as 64% to 77% for soft-tissue injury and a reported false-positive rate of 25% to 40% [42,62]. Soft-tissue edema and signal changes are often slow to resolve, persisting well after the patient has become asymptomatic. Conversely, subacute to chronic soft-tissue injuries can be difficult to appreciate once soft-tissue edema has subsided, and it is often challenging to determine integrity of scarred ligaments. For these reasons, flexion- extension radiographs may be complementary to MRI, and performed flexion-extension radiographs may better determine cervical instability in the setting of subacute or chronic cervical spine injury. Much research has been performed in an attempt to identify MRI findings that can be used to diagnose or help provide a prognosis for WAD [85,86,88,89,91-97,102,103]. These studies have primarily focused on signal changes within the craniocervical (alar and transverse) ligaments, atrophy of the paraspinal muscles, and progression of cervical degenerative changes as indicators of WAD. Associations between MRI findings and WAD are weak at best [86,87], and most studies have found no difference in MRI findings between WAD patients and non-WAD patients [85,92,94-97,103] and no correlation between MRI findings and WAD symptoms or progression [88,89]. MRA Neck There is no role for MRA in the assessment of patients with persistent pain on follow-up visit with cervical collar in place. Suspected Spine Trauma Arteriography Cervicocerebral There is no role for arteriography in the assessment of patients with persistent pain on follow-up visit with cervical collar in place.