Pain in the the neck
What is the yield of MRI in patients with negative c-spine CT but persistent neck pain? In this prospective study, 767 patients in this scenario had MRI. They found abnormalities in 23.6%. But only 11/767 (1.4%) needed surgery. None got a halo. Of the 11 surgical patients, 6 had an abnormal neuro exam. So only 5/767 patients (0.65%) had negative CT and normal exam but had a change in management based on MRI.
MRI rarely changes management in patients with negative CT and persistent neck pain.
J Trauma Acute Care Surg. 2017 Feb;82(2):263-269. doi: 10.1097/TA.0000000000001322.
Cervical spine MRI in patients with negative CT: A prospective, multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT).
Maung AA1, Johnson DC, Barre K, Peponis T, Mesar T, Velmahos GC, McGrail D, Kasotakis G, Gross RI, Rosenblatt MS, Sihler KC, Winchell RJ, Cholewczynski W, Butler KL, Odom SR, Davis KA; ReCONECT MRI C-SPINE Study Group.
1From the Yale School of Medicine (A.A.M., D.C.J., K.B., K.A.D.), New Haven, Connecticut; Massachusetts General Hospital (T.P., T.M., G.C.V., K.L.B.), Boston, Massachusetts; Boston Medical Center (D.M., G.K.), Boston, Massachusetts; Baystate Medical Center (R.I.G.), Springfield, Massachusetts; Lahey Hospital and Medical Center (M.S.R.), Burlington, Massachusetts; Maine Medical Center (K.C.S., R.J.W.), Portland, Maine; Bridgeport Hospital (W.C.), Bridgeport, Connecticut; and Beth Israel Deaconess Medical Center (S.R.O.), Boston, Massachusetts.
Although cervical spine CT (CSCT) accurately detects bony injuries, it may not identify all soft tissue injuries. Although some clinicians rely exclusively on a negative CT to remove spine precautions in unevaluable patients or patients with cervicalgia, others use MRI for that purpose. The objective of this study was to determine the rates of abnormal MRI after a negative CSCT.
Blunt trauma patients who either were unevaluable or had persistent midline cervicalgia and underwent an MRI of the C-spine after a negative CSCT were enrolled prospectively in eight Level I and II New England trauma centers. Demographics, injury patterns, CT and MRI results, and any changes in cervical spine management as a result of MRI imaging were recorded.
A total of 767 patients had MRI because of cervicalgia (43.0%), inability to evaluate (44.1%), or both (9.4%). MRI was abnormal in 23.6% of all patients, including ligamentous injury (16.6%), soft tissue swelling (4.3%), vertebral disc injury (1.4%), and dural hematomas (1.3%). Rates of abnormal neurological signs or symptoms were not different among patients with normal versus abnormal MRI. (15.2 vs. 18.8%, p = 0.25). The c-collar was removed in 88.1% of patients with normal MRI and 13.3% of patients with an abnormal MRI. No patient required halo placement, but 11 patients underwent cervical spine surgery after the MRI results. Six of the eleven had neurological signs or symptoms.
In a select population of patients, MRI identified additional injuries in 23.6% of patients despite a normal CSCT. It is uncertain if this is a true limitation of CT technology or represents subtle injuries missed in the interpretation of the scan. The clinical significance of these abnormal MRI findings cannot be determined from this study group.
LEVEL OF EVIDENCE:
Therapeutic study, level IV.
PMID: 27893647 [PubMed – in process]