A retrospective study on the utility of neck MRI scans following normal CT and Xray

Following acute blunt cervical trauma, spinal cord injury carries a heavy disease burden. With such high morbidity at stake, it is crucial not to miss the diagnosis of cervical spine injuries in order to prevent spinal cord injuries. Establishment of cervical spine clearance is a common clinical conundrum encountered by health care professionals. CT has superseded plain radiographs as the primary screening modality. Nonetheless, a proportion of cervical injuries are caused by soft tissue injuries which may not be detected on CT scan alone. In patients with normal CT scans and plain radiographs who have persistent neck pain, focal neurology or are clinically unassessable due to altered mental status, there is ongoing debate regarding the reliability of CT scans in excluding cervical injuries versus the need for further imaging with MRI. Albeit frequently performed, the utility and cost-effectiveness of MRI remains an ongoing debate and requires further validation. Thus, the primary objective of this study was to determine the incidence of additional findings on MRI imaging that were not previously detected on CT scan. A single-centre, retrospective analysis was conducted at Tertiary care, Level 1 Trauma Centre in Western Australia using keyword searches on the PACS-RIS (Picture Archiving and Communication System- Radiology Information System) imaging database including the following terms: “cervical”, “injury”, “rupture”, “sprain”, “strain”, “tear”, “tenderness”. The search included scans performed from 1st January 2004 to 2nd October 2017. No participant involvement was required in this study. Patients who had a normal CT scan or plain radiographs and subsequently underwent an MRI scan to rule out potential cervical injuries were included in the study. Reports of the MRI scans were obtained and the incidence of abnormalities found on MRI was evaluated as the primary endpoint. The MRI must be performed within the same admission as the acute injury. The secondary endpoint was the percentage of patients with normal CT scans or plain radiographs whose management was altered following additional abnormalities found on MRI. To quantify this, management of patients was followed up from discharge summaries, inpatient notes and/or outpatient clinic notes from the medical records.