Acute cervical spine injuries prospective MR imaging assessment at a level1 trauma center

PURPOSE: To determine the weighted average sensitivity of magnetic resonanc e (MR) imaging in the prospective detection of acute neck Injury and to com pare these findings with those of a comprehensive conventional radiographic assessment. MATERIALS AND METHODS: Conventional radiography and MR imaging were perform ed in 199 patients presenting to a level 1 trauma center with suspected cer vical spine injury. Weighted sensitivities and specificities were calculate d, and a weighted average across eight vertebral levels from C1 to T1 was f ormed. Fourteen parameters indicative of acute injury were tabulated. RESULTS: Fifty-eight patients had 172 acute cervical injuries. MR imaging d epicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average s ensitivity, 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 hemo rrhage or edema, anterior or posterior longitudinal ligament injury, trauma tic disk herniation, cord edema, and cord compression. Cord injuries were a ssociated 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 o f a wide spectrum of neck injuries, and further study is warranted of its p otential effect on medical decision making, clinical outcome, and cost-effe ctiveness.