title: The value of cervical magnetic resonance imaging in the evaluation of the obtunded or comatose patient with cervical trauma, no other abnormal neurological findings, and a normal cervical computed tomography.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, The University of California Davis Medical Center, Sacramento, California 95817, USA.
authors.forename: Pavan
authors.initials: P
authors.lastname: Khanna
authors.forename: Cam
authors.initials: C
authors.lastname: Chau
authors.forename: Arthur
authors.initials: A
authors.lastname: Dublin
authors.forename: Kee
authors.initials: K
authors.lastname: Kim
authors.forename: David
authors.initials: D
authors.lastname: Wisner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*; D055815:Young Adult