Department of Radiology, The University of California Davis Medical Center, Sacramento, California 95817, USA.
J Trauma Acute Care Surg. 2012 Mar;72(3):699-702. doi: 10.1097/TA.0b013e31822b77f9.
The value of magnetic resonance imaging (MRI) in the evaluation of the obtunded or comatose patient with a potential neck injury is a controversial subject. Some authors have suggested that MRI of the cervical spine adds no value in the evaluation of patients with a normal computed tomography (CT) of the neck. However, others have suggested that MRI is the gold standard for clearing the cervical spine in a clinically suspicious or unevaluatable blunt trauma patient. The purpose of this study is to evaluate our data in regard to these conflicting hypotheses.
Five consecutive years of data from 17,000 patients seen at our Level I trauma center yielded 512 individuals who underwent both CT and MRI of the cervical spine. Of the latter group, 150 individuals met three strict inclusion criteria for this study: (1) obtundation (Glasgow Coma Scale ≤13, with 94 of this group comatose [Glasgow Coma Scale ≤8]); (2) no obvious neurologic deficits; and (3) a normal cervical CT. The effect of MRI on the clinical management of these patients was evaluated.
Among the 150 obtunded or comatose patients with a negative CT, the majority (51%) had a normal MRI. Among the patients with a positive MRI, the most common MRI-positive findings were ligamentous and soft tissue injury (81%). However, no MRI findings were deemed unstable, and no surgical intervention or change in the clinical management aside from collar immobilization of these individuals occurred after MRI.
The addition of a cervical MRI to the evaluation protocol of obtunded or comatose patients with an otherwise normal neurologic examination and a normal cervical CT did not provide any additional useful information to change the management of these patients.
对于潜在颈部损伤而意识障碍或昏迷的患者，磁共振成像（MRI）在评估中的价值是一个有争议的问题。一些作者认为，颈椎 MRI 对颈椎 CT 正常的患者评估没有价值。然而，其他人认为 MRI 是临床可疑或无法评估的钝性创伤患者颈椎清除的金标准。本研究旨在评估我们在这些相互矛盾的假设方面的数据。
我们的一级创伤中心连续 5 年的 17000 例患者的数据中，有 512 例患者同时接受了颈椎 CT 和 MRI 检查。在后一组中，有 150 例符合本研究的三个严格纳入标准：（1）意识障碍（格拉斯哥昏迷量表≤13，其中 94 例昏迷[格拉斯哥昏迷量表≤8]）；（2）无明显神经功能缺损；（3）颈椎 CT 正常。评估了 MRI 对这些患者临床管理的影响。
在 150 例 CT 阴性意识障碍或昏迷的患者中，大多数（51%）的 MRI 正常。在 MRI 阳性的患者中，最常见的 MRI 阳性发现是韧带和软组织损伤（81%）。然而，没有 MRI 发现不稳定，除了这些患者的颈托固定外，没有进行手术干预或改变临床管理。
在其他方面神经检查正常且颈椎 CT 正常的意识障碍或昏迷患者的评估方案中增加颈椎 MRI 并不能提供任何额外的有用信息来改变这些患者的治疗方法。
