Utility of MRI for cervical spine clearance in blunt trauma patients
after a negative CT
Diego B. Nunez
Received: 18 August 2017 / Revised: 4 December 2017 / Accepted: 22 December 2017 /Published online: 15 February 2018
European Society of Radiology 2018
Purpose To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast
cervical spine CT.
Methods A review of medical records identified all adult patients with blunt trauma who underwent CT cervical spine followed
by MRI within 48 h over a 33-month period. Utility of subsequent MRI was assessed in terms of findings and impact on outcome.
Results A total of 1,271 patients with blunt cervical spine trauma underwent both cervical spine CT and MRI within 48 h; 1,080
patients were included in the study analysis. Sixty-six percent of patients with a CT cervical spine study had a negative study. Of
these, the subsequent cervical spine MRI had positive findings in 20.9%; 92.6% had stable ligamentous or osseous injuries, 6.0%
had unstable injuries and 1.3% had potentially unstable injuries. For unstable injury, the NPV for CT was 98.5%. In all 712
patients undergoing both CT and MRI, only 1.5% had unstable injuries, and only 0.42% had significant change in management.
Conclusions MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain
patients with persistent abnormal neurological examination.
• MRI has limited utility after negative cervical CT in blunt trauma.
• MRI is frequently positive for non-specific soft-tissue injury.
• Unstable injury missed on CT is infrequent.
Keywords Spinal injuries
Magnetic resonance imaging
Soft tissue injuries
ALL Anterior Longitudinal Ligament
CSI Cervical spine injury
CT Computed tomography
ED Emergency department
GCS Glasgow Coma Scale
IRB Institutional Review Board
MRI Magnetic resonance imaging
MVA Motor vehicle accident
NEXUS National Emergency XRadiography Utilization
NPV Negative predictive value
PLC Posterior ligamentous complex
PLL Posterior longitudnal ligament
Acute cervical spine injury (CSI) is not uncommon after blunt
trauma and has been reported in 2–6% of cases [1, 2]. Early
detection is critical because delayed or un-diagnosed unstable
injury can lead to severe morbidity and mortality[3–5]. Five to
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00330-017-5285-y) contains supplementary
material, which is available to authorized users.
* Ajay Malhotra
Department of Radiology and Biomedical Imaging, Yale School of
Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New
Haven, CT 06520-8042, USA
Yale School of Medicine, New Haven, CT, USA
Department of Neurosurgery, Yale School of Medicine, New
Haven, CT, USA
Division Chief of Neuroradiology, Director Emergency Radiology,
Brigham and Women’s and Hospital, Harvard Medical School,
Boston, MA, USA
Department of Radiology Northwell Health, New York, NY, USA
European Radiology (2018) 28:2823–2829