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Certical Spine MRI In Patients With Acute Cervical Spine Fractures 2003

Lin JT, Lee JL, Mango T, Lee ST
University Hospital at Stony Brook
Stony Brook, NY

Purpose:
To evaluate the incidence and significance of MR imaging findings in patients with acute cervical spine fractures.
Materials and Methods: MR imaging findings of patients at a large teaching hospital (a Level I trauma center) presenting with cervical spine fractures on radiographs and CT over a seven-year period were reviewed. We noted specific MR imaging findings in 67 patients, determining if MR imaging added additional information compared to CT and radiographs. The clinical significance of MR imaging findings was then determined by the Orthopedic Surgery attending specializing in cervical spine trauma.

Summary of Results:
MR imaging findings were positive in 40% (27/67) for ligamentous injury, 34% (23/67) for herniated discs, 24% (16/67) for spinal cord compression, 16% (11/67) for spinal cord contusion, and 13% (9/67) for epidural hematoma. Compared to CT and radiographs, MR imaging was positive in only 42% (28/67) for evident fracture and 33% (22/67) for abnormal marrow signal (edema or hemorrhage). MR imaging was positive in 46% (31/67) for soft tissue injury (edema or hemorrhage), 28% (19/67) for compromise of the spinal canal, and 27% (18/67) for dislocation. Compared to CT and radiographs, MR imaging provided additional information in 58% (39/67) of cases. In 34% (23/67) of patients, MR imaging results affected patient management.

Conclusion:
This is the first study to demonstrate the incidence of MR findings in patients with known cervical spine fractures and to evaluate the significance of the MR findings in acute patient management. MR imaging provided additional information in 58% of cases, compared to CT and radiographs, including clinically significant information on ligamentous injury, herniated discs, epidural hematoma, compromise of the spinal canal, and spinal cord compression. These MR imaging findings were clinically significant in 34% of cases, highlighting the critical role of MR in excluding serious associated injuries in patients with cervical spine fractures.

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Presenting authors: Steven T. Lee, MD and Julie T. Lin, MD (non-ASSR members)
Previously presented at the 2000 Eastern Neuroradiological Society and 2000 American Society of Emergency Radiology Meeting.