RSNA 2016: Acute findings present on C-spine MR images on acute trauma patients

On Day 4 of RSNA, attendees heard from Marlen Pajcini, MD who presented, “Is MR of the C-spine in Acute Trauma Patients Indicated?”

With many trauma centers making MR of the cervical spine a routine imaging protocol for selected indications, Pajcini studied the spectrum and frequency of findings in MR performed at the Level I trauma center, to establish its effectivenesss.

“Understanding the frequency of findings on C-spine MR imaging studies on acute trauma patients can allow radiologists to guide ordering physicians in appropriate utilization,” said Pajcini.

A retrospective review of consecutive C-spine MR imaging studies over a two-year period ordered in the context of an acute trauma was performed, with 241 studies identified.

Cord injury, which can have the most severe clinical repercussions was noted in 17 percent of MR, ligamentous injury, the most common pathological finding in MR was noted at 43 percent, soft tissue/muscle injury in 29 percent, marrow/disk injury in 28 percent, and vascular injury in 12 percent.

Some 36 percent of the images had no acute findings or the MR study demonstrated only findings that were seen on imaging studies done beforehand.

“This indicates that in the majority of trauma patients for which a C-spine MR study is ordered, an acute finding is generally present. While there may be variations in treatment protocols among trauma centers in response to specific findings on MR, the overall high frequency of positive findings found in our study validates the general concept of the use of MR in acutely injured patients who demonstrate neurologic deficit or cannot be assessed clinically,” noted Pajcini.