Bharti Khurana1, Abhishek Keraliya2, George Velmahos3, Adrian A Maung4,5, Christopher M Bono6, Mitchel B Harris6. 1. Trauma Imaging Research and Innovation Center, Department of Radiology, Brigham and Women's Hospital, 75 Francis St., MA, 02115, Boston, USA. bkhurana@bwh.harvard.edu. 2. Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA. 3. Trauma, Emergency Surgery, Surgery Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA. 4. Yale New Haven Hospital, New Haven, USA. 5. Department of Surgery, Yale School of Medicine, New Haven, USA. 6. Department of Orthopedics, Massachusetts General Hospital, MA, 02114, Boston, USA.
Abstract
PURPOSE: To review and analyze the clinical significance of positive acute traumatic findings seen on MRI of the cervical spine (MRCS) following a negative CT of the cervical spine (CTCS) for trauma. METHODS: We performed a sub-cohort analysis of 54 patients with negative CTCS and a positive MRCS after spine trauma from the previous multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Both CTCS and MRCS were independently reviewed by two emergency radiologists and two spine surgeons. The surgeons also commented on the clinical significance of the traumatic findings seen on MRCS and grouped them into unstable, potentially unstable, and stable injuries. RESULTS: Among 35 unevaluable patients, MRCS showed one unstable (hyperextension) and two potentially unstable (hyperflexion) injuries. Subtle findings were seen on CTCS in 2 of 3 patients upon careful retrospective review that would have suggested these injuries. Of 19 patients presenting with cervicalgia, 2/5 (40%) patients with neurological deficit demonstrated clinically significant findings on MRCS with predisposing factors seen on CT. None of the 14 patients with isolated cervicalgia and no neurological deficit had clinically significant findings on their MRCS. CONCLUSION: While CTCS is adequate for clearing the cervical spine in patients with isolated cervicalgia, MRCS can play a critical role in patients with neurological deficits and normal CTCS. Clinically significant traumatic findings were seen in 8.5% of unevaluable patients on MRCS, though these injuries in fact could be identified on the CT in 2 of 3 patients upon careful retrospective review.
PURPOSE: To review and analyze the clinical significance of positive acute traumatic findings seen on MRI of the cervical spine (MRCS) following a negative CT of the cervical spine (CTCS) for trauma. METHODS: We performed a sub-cohort analysis of 54 patients with negative CTCS and a positive MRCS after spine trauma from the previous multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Both CTCS and MRCS were independently reviewed by two emergency radiologists and two spine surgeons. The surgeons also commented on the clinical significance of the traumatic findings seen on MRCS and grouped them into unstable, potentially unstable, and stable injuries. RESULTS: Among 35 unevaluable patients, MRCS showed one unstable (hyperextension) and two potentially unstable (hyperflexion) injuries. Subtle findings were seen on CTCS in 2 of 3 patients upon careful retrospective review that would have suggested these injuries. Of 19 patients presenting with cervicalgia, 2/5 (40%) patients with neurological deficit demonstrated clinically significant findings on MRCS with predisposing factors seen on CT. None of the 14 patients with isolated cervicalgia and no neurological deficit had clinically significant findings on their MRCS. CONCLUSION: While CTCS is adequate for clearing the cervical spine in patients with isolated cervicalgia, MRCS can play a critical role in patients with neurological deficits and normal CTCS. Clinically significant traumatic findings were seen in 8.5% of unevaluable patients on MRCS, though these injuries in fact could be identified on the CT in 2 of 3 patients upon careful retrospective review.
Authors: Francesco Alessandrino; Christopher M Bono; Christopher A Potter; Mitchel B Harris; Aaron D Sodickson; Bharti Khurana Journal: Emerg Radiol Date: 2019-03-31
Authors: Brian M Fisher; Steven Cowles; Jennifer R Matulich; Bradley G Evanson; Diana Vega; Sharmila Dissanaike Journal: Am J Surg Date: 2013-10-10 Impact factor: 2.565
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