磁共振成像是否正在成为颈椎清除的新 CT？一级创伤中心磁共振成像利用率的趋势。

Is magnetic resonance imaging becoming the new computed tomography for cervical spine clearance? Trends in magnetic resonance imaging utilization at a Level I trauma center.

机构信息

From the Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery (R.H., R.F.A., D.R.M., E.J.L., G.B.), and Department of Orthopedics (R.C.R., T.T.K.), Cedars-Sinai Medical Center, Los Angeles, California.

出版信息

J Trauma Acute Care Surg. 2020 Aug;89(2):365-370. doi: 10.1097/TA.0000000000002752.

DOI:10.1097/TA.0000000000002752

PMID:32744833

Abstract

BACKGROUND

Increasing evidence supports the limited use of magnetic resonance imaging (MRI) for cervical spine (C-spine) clearance following blunt trauma. We sought to characterize the utilization of MRI of the C-spine at a Level I trauma center.

METHODS

All blunt trauma patients undergoing a computed tomography (CT) of the C-spine between January 2009 and December 2018 were reviewed. The CT and MRI results, demographics, clinical presentation, subspecialty consultations, and interventions were recorded. The MRI results were considered clinically significant if they resulted in cervical thoracic orthosis/halo placement or surgical intervention. Linear regression models were utilized to identify trends.

RESULTS

There were 9,101 patients that underwent a CT of the C-spine, with 513 (5.6%) being positive for an acute injury. MRI was obtained for 375 (4.1%) of patients. A linear increase in the proportion of patients undergoing an MRI was noted, from 0.9% in 2009 to 5.6% in 2018 (p < 0.01). Of the 513 patients with a positive CT, 290 (56.5%) had an MRI. In 40 (13.8%) of them, the CT demonstrated a minor injury. Clinically significant MRI findings were noted only in two (5.0%) of the 40 patients, and both had a neurologic deficit on initial examination. Of the 8,588 patients with a negative CT, 85 (1.0%) underwent an MRI. Of those, 9 (10.6%) had a clinically significant MRI with all but one presenting with a neurological deficit.

CONCLUSION

MRI is increasingly utilized for C-spine clearance following blunt trauma. MRI was exceedingly unlikely to demonstrate a clinically significant finding in the absence of a neurological deficit, when the CT was negative or included minor injuries. Trauma centers are encouraged to constantly evaluate their own practices and intervene with education and collaboration to limit the excessive use of unnecessary resources.

LEVEL OF EVIDENCE

Therapeutic/Care Management Study, Level III or IV. Diagnostic test, level IV.

摘要

背景

越来越多的证据支持在钝性创伤后有限地使用磁共振成像（MRI）来清除颈椎（C 脊柱）。我们旨在描述一级创伤中心 C 脊柱 MRI 的使用情况。

方法

回顾了 2009 年 1 月至 2018 年 12 月期间接受 C 脊柱计算机断层扫描（CT）的所有钝性创伤患者。记录了 CT 和 MRI 结果、人口统计学资料、临床表现、专科会诊和干预措施。如果 MRI 结果导致颈胸支具/环固定或手术干预，则认为 MRI 结果具有临床意义。使用线性回归模型来确定趋势。

结果

共有 9101 例患者接受了 C 脊柱 CT 检查，其中 513 例（5.6%）有急性损伤。对 375 例（4.1%）患者进行了 MRI 检查。接受 MRI 检查的患者比例呈线性增加，从 2009 年的 0.9%增加到 2018 年的 5.6%（p < 0.01）。在 513 例 CT 阳性的患者中，有 290 例（56.5%）进行了 MRI。在其中 40 例（13.8%）中，CT 显示有轻微损伤。仅在 40 例患者中的 2 例（5.0%）中发现有临床意义的 MRI 结果，并且这 2 例患者在初次检查时均有神经功能缺损。在 8588 例 CT 阴性的患者中，有 85 例（1.0%）接受了 MRI。其中，有 9 例（10.6%）有临床意义的 MRI，除 1 例外均有神经功能缺损。