Mohamed Mohamed A, Majeske Karl D, Sachwani-Daswani Gul, Coffey Daniel, Elghawy Karim M, Pham Amanda, Scholten Donald, Wilson Kenneth L, Mercer Leo, McCann Michael L
Hurley Medical Center, Flint, Michigan, USA.
Trauma Surg Acute Care Open. 2016 Oct 19;1(1):e000016. doi: 10.1136/tsaco-2016-000016. eCollection 2016.
Owing to the potential risks associated with missed injury, many blunt trauma patients with suspected cervical spine injury undergo some form of imaging technique which has progressed from primarily using plain radiography to relying on CT. Recently, studies have shown that in certain situations, adding MRI may improve the diagnostic accuracy over solely relying on CT.
Retrospective study of 3468 adult blunt trauma patients at a level I trauma center of which 94 with an initial negative CT scan underwent subsequent MRI. These 94 patients were classified as reliable or unreliable for examination; coded as either having a positive or negative MRI result; and assessed for a change in management.
Of the 94 patients in the study population, 69 (73.4%) were deemed reliable and 25 (26.6%) deemed unreliable for examination. Overall, 65 (69.1%) patients had a positive MRI result-49 (71.0%) reliable and 16 (64.0%) unreliable-with some patients testing positive for more than one finding. There was no significant difference in positive MRI rates between reliable and unreliable patients. None of the 29 patients who had negative MRI had a change in management, while 31 of the 65 (47.7%) patients with positive MRI did have a change in management of either continued cervical collar immobilization or neck surgery.
The use of CT scans should be continued as the primary imaging technique for patients with suspected cervical spine injuries. In cases where obtundation or clinical suspicion exists for a false-negative CT scan, MRI should be considered as a supplement and should not be rejected solely based on the negative result of the CT.
Level IV.
由于漏诊损伤存在潜在风险，许多疑似颈椎损伤的钝性创伤患者会接受某种形式的成像技术检查，该技术已从主要使用X线平片发展到依赖CT。最近的研究表明，在某些情况下，增加MRI检查可能比单纯依靠CT能提高诊断准确性。
对一家一级创伤中心的3468例成年钝性创伤患者进行回顾性研究，其中94例初始CT扫描结果为阴性的患者随后接受了MRI检查。这94例患者被分类为检查可靠或不可靠；根据MRI结果编码为阳性或阴性；并评估治疗方案的变化。
在研究人群的94例患者中，69例（73.4%）被认为检查可靠，25例（26.6%）被认为不可靠。总体而言，65例（69.1%）患者MRI结果为阳性，其中49例（71.0%）可靠，16例（64.0%）不可靠，有些患者不止一项检查结果为阳性。可靠和不可靠患者的MRI阳性率无显著差异。29例MRI结果为阴性的患者中无一例治疗方案有变化，而65例（47.7%）MRI结果为阳性的患者中有31例治疗方案有变化，包括继续使用颈托固定或进行颈部手术。
对于疑似颈椎损伤的患者，应继续将CT扫描作为主要成像技术。在存在意识不清或临床怀疑CT扫描结果为假阴性的情况下，应考虑将MRI作为补充检查，不应仅基于CT的阴性结果而拒绝MRI检查。
四级。
