40-Slice Multidetector CT: Is MRI Still Necessary for Cervical Spine Clearance after Blunt Trauma?

Abstract

We have recently demonstrated that 16-slice multidetector CT (MDCT) is insufficient for cervical spine (CS) clearance in patients with unreliable examinations after blunt trauma. The purpose of this study was to determine if a negative CS CT using 40-slice MDCT is sufficient for ruling out CS injury in unreliable blunt trauma patients or if MRI remains necessary for definitive clearance. In addition, we sought to elucidate the frequency by which MRI alters treatment in patients with a negative CS CT who have a reliable examination with persistent clinical symptoms. The trauma registry was used to identify all patients with blunt trauma who had a negative CS CT on admission using 40-slice MDCT and a subsequent CS MRI during their hospitalization from July 2006 to July 2007. Two hundred thirteen patients were identified. Overall, 24.4 per cent patients had abnormal MRIs. Fifteen required operative repair; 23 required extended cervical collar; and 14 had collars removed. A total of 8.3 per cent of patients with an unreliable examination and 25.6 per cent of reliable patients had management changed based on MRI findings. Overall, MRI changed clinical practice in 17.8 per cent of all patients. Despite newer 40-slice CT technology, MRI continues to be necessary for CS clearance in patients with unreliable examinations or persistent symptoms.

Impact of MRI on changing management of the cervical spine in blunt trauma patients with a ‘negative’ CT scan

“…We used a GCS score of 13 or less on initial presentation to define obtunded patients. Similar studies have used a GCS of 13 or less, 6 15 or a GCS score of 14 or less 9 11 16 17 to describe patients who are obtunded or unreliable for examination. Intoxicated patients were deemed as such if they either had a recent history of ingestion of an intoxicating agent, evidence on examination or via positive laboratory testing.…”

Cervical spine injury with negative computed tomography finding

“…In contrast to Como et al., Menaker et al. conducted two retrospective studies comparing the use of CT and MRI to clear the CS in obtunded patients and found that MRI CS identified 8.9% 9 and 24.4% 10 abnormal findings in spite of negative CT reports. Based on these findings, some of these patients required operative management or remained in cervical collar for an extended time period.…”

Cervical spine clearance in trauma patients

“…The authors concluded that MRI should be used routinely for cervical spine clearance in patients who are unable to participate in clinical assessment. Further work conducted by Menaker et al 41 found that 15.6% of a study subset of 96 unreliable patients had injury detected on MRI after negative 40 slice CT imaging, including spinal cord compression requiring operative management. The authors concluded that modern, multislice CT imaging was still inadequate for definitive spinal clearance in patients unable to be clinically assessed.…”