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MRI Is Non-Diagnostic in the Cervical Spine Imaging of the Helmeted Football Player with Shoulder Pads 2003

Waninger, K. N.; Rothman, M. I. (presenting author, ASSR member).; Heller, M.
Saint Luke's Hospital
Bethlehem, PA

Introduction:
It is currently recommended that helmet and shoulder pads remain in place during the initial clinical and radiographic evaluation of the helmeted athlete with a potential cervical spine injury. The objective of this prospectively designed, single subject study is to study whether MRI may play a role in the initial evaluation and management of the helmeted football player with a cervical spine injury.

Method:
One male was fitted using equipment (football helmet @ Riddell, shoulder pads @ Douglas worn during the collegiate season at Lehigh University. Standard MRI using a routine clinical 0.7T High Field Open MRI scanner (GE Signa System, Milwaukee, WI) was employed for the evaluation using standard clinical parameters (Sagittal T1, FSE-T2, STIR and axial FSE-T2 series). All series were reviewed by a single board-certified fellowship-trained neuroradiologist Studies were evaluated for image clarity and diagnostic capability in this clinical setting.

Results:
Standard MRI series were all of extremely limited quality, even using sequences and slice selection designed to minimize artifact associated with metals (fast spin echo T-2 weighted
series). When all MRI series were reviewed as a whole, sufficient evidence was not available to allow clinical decision-making.

Conclusion:
The amount and type of metal within the standard football helmet and shoulder pads results in sufficient field inhomogeneity and SKEW artifact to preclude adequate evaluation of the cervical structures, rendering MRI evaluation in this setting not clinically useful. This study demonstrates
that current MRI techniques play no role in the clearance of the cervical spine (with currently available brands of helmet and shoulder pads in place) without prior equipment removal or manipulation.