Matthew Ditzler MD, Presenter: Nothing to Disclose

Thaddeus Sze MD, Abstract Co-Author: Nothing to Disclose

Eric Michael Walser MD, Abstract Co-Author: Nothing to Disclose

Evaluate the value of MRI following CT evaluation of traumatic spinal injury at a Level 1 trauma center. 

We evaluated the records of 190 adult ER trauma patients who received a spinal MRI examination within 2 weeks of a spinal CT from 2010-2013. We reviewed the radiographic reports and findings for this cohort of patient on CT and MRI, the extent of cross-modality agreement, the post-imaging management, and length of hospital stay (LOS). The patients were analyzed regarding the concordance of CT and subsequent MRI findings; when the MRI results were discordant we investigated whether or not these findings altered subsequent care. 

Of the 190 patients included within the study, 102 (54%) underwent a CT examination with any positive finding. 76 of these patients received a concordant MRI examination; 26 patients had a discordant MRI examination demonstrating either an acute compression fracture or a non-compression fracture/ligamentous injury. 88 patients (46%) initially received a negative CT examination. 77 of those patients had a concordant MRI examination; 11 patients underwent a discordant MRI examination. These 11 examinations showed either chronic disc disease or spinal stenosis; none demonstrated an acute traumatic injury or changed patient management. 5 patients (2%) required surgical intervention and all had diagnostic findings by CT scan. The LOS for patients with discordant MRI examinations ranged from 0 to 38 days with a mean and median of 5 and 2 days respectively.  

MRI examination of the spine in the setting of trauma has a role in clarifying the acuity and extent of CT findings but is not necessary in cases where the initial CT exam is negative for traumatic injury. Further, the CT findings alone were diagnostic in those few patients requiring surgical intervention (2% of our study group).  

For trauma patients, the routine acquisition of an MRI after a normal spine CT is unnecessary. MRI can clarify positive findings on CT but may not alter subsequent patient management in regards to surgical intervention.

Ditzler, M, Sze, T, Walser, E, Total Spine MRI in Trauma: Who Should Get It?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014808.html