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Acute Cervical Spine Injuries: Prospective MR Imaging Assessment at a Level 1 Trauma Center¹

¹ From the Department of Radiology, University of California-Davis Medical Center, 4701 X St, Sacramento, CA 95817 (R.W.K., P.F.B., M.I., C.S.B., W.R.N., R.A.M., F.K.O., D.M.B., V.C.P., B.W.C.) and the Department of Biostatistics, University of California at Davis (C.M.D., R.A.L.). Received October 15, 1998; revision requested November 11; revision received December 28; accepted April 30, 1999. Supported in part by Hitachi, Tokyo, Japan. Address reprint requests to R.W.K.

PURPOSE: To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment.

MATERIALS AND METHODS: Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated.

RESULTS: Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001).

CONCLUSION: MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

Index terms: Magnetic resonance (MR), comparative studies, 31.121411, 31.121412 • Spinal cord, injuries, 341.41, 341.42, 341.444 • Spine, CT, 31.1211 • Spine, injuries, 31.41, 34.42, 34.444 • Spine, MR, 31.121411, 31.121412 • Spine, radiography, 31.11 • Trauma, 31.40

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