Le texte complet de cet article est disponible en PDF.
CT occult cervical spine injuries are common in blunt trauma and MRI is useful in identifying them.
Upper extremity deficit and others are important clinical indications for MRI.
These indications have positive predictive values of 20% and higher.
Positive cervical spine MRI alters patient management in the majority of the cases.
Surgical intervention is infrequently needed in this population though not trivial.
Background and purpose
Cervical spine injury is common in the setting of blunt trauma and there is consensus that cervical spine CT (CSCT) is the image modality of choice for initial evaluation for blunt trauma related injuries of the cervical spine. However, there is disagreement in the literature with regards to further evaluation of blunt trauma patients with cervical spine MRI (CSMRI) after negative CSCT when there is persistent clinical concern for occult trauma related injury. The purpose of this study is to examine the utility of CSMRI for detection of occult injury in blunt trauma patients after negative CSCT.
Materials and methods
We reviewed records for 7,301 patients admitted for blunt trauma (November 2007–December 2013) and identified 259 who underwent CSMRI after a negative CSCT. These CSMRIs were reviewed to determine the number and type of significant CT occult injuries identified and clinical indications that led to CSMRI acquisition.
Results and conclusions
CSMRI detected significant injuries following negative CSCT in 31% (81/259) of patients. There were 15 cord contusions/infarcts, 9 bone contusions/fractures, 7 spinal canal hemorrhages and 66 soft tissue injuries. Upper extremity neurological deficit had greatest positive predictive value (PPV) for detection of CT-occult injury on CSMRI of 43% (23/53), followed by equivocal CSCT findings (38%, 18/47), presence of extra-cervical injuries (34%, 20/58), midline cervical tenderness (20%, 17/85), and isolated lower extremity neurological deficit (0%, 0/16). CSMRI is recommended following negative CSCT in the evaluation of blunt cervical spine trauma when appropriate clinical concerns are present.Le texte complet de cet article est disponible en PDF.
Keywords : Magnetic resonance imaging, Computed tomography, Cervical spine injury, Blunt trauma, Occult injury