Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT

Eur Radiol. 2018 Jul;28(7):2823-2829. doi: 10.1007/s00330-017-5285-y. Epub 2018 Feb 15.

Abstract

Purpose: To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast cervical spine CT.

Methods: A review of medical records identified all adult patients with blunt trauma who underwent CT cervical spine followed by MRI within 48 h over a 33-month period. Utility of subsequent MRI was assessed in terms of findings and impact on outcome.

Results: A total of 1,271 patients with blunt cervical spine trauma underwent both cervical spine CT and MRI within 48 h; 1,080 patients were included in the study analysis. Sixty-six percent of patients with a CT cervical spine study had a negative study. Of these, the subsequent cervical spine MRI had positive findings in 20.9%; 92.6% had stable ligamentous or osseous injuries, 6.0% had unstable injuries and 1.3% had potentially unstable injuries. For unstable injury, the NPV for CT was 98.5%. In all 712 patients undergoing both CT and MRI, only 1.5% had unstable injuries, and only 0.42% had significant change in management.

Conclusions: MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain patients with persistent abnormal neurological examination.

Key points: • MRI has limited utility after negative cervical CT in blunt trauma. • MRI is frequently positive for non-specific soft-tissue injury. • Unstable injury missed on CT is infrequent.

Keywords: Magnetic resonance imaging; Neck injuries; Soft tissue injuries; Spinal injuries; Wounds Nonpenetrating.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cervical Vertebrae / injuries*
  • Cervical Vertebrae / pathology*
  • Contrast Media
  • Delayed Diagnosis
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Neurologic Examination / methods
  • Soft Tissue Injuries / pathology
  • Spinal Injuries / pathology
  • Tomography, X-Ray Computed / methods
  • Wounds, Nonpenetrating / pathology*
  • Young Adult

Substances

  • Contrast Media