title: MR Imaging of the Cervical Spine in Nonaccidental Trauma: A Tertiary Institution Experience.
abstract: OBJECTIVE
  Cervical MR imaging has demonstrated a utility for detecting soft tissue injury in nonaccidental trauma. The purpose of this study was to identify the incidence and types of cervical spine injury on MR imaging in nonaccidental trauma and to correlate cervical spine injury with parenchymal injury on brain MR imaging and findings on head CT.
  
  
  METHODS
  A retrospective review of children diagnosed with nonaccidental trauma in a tertiary referral pediatric hospital over 8 years was performed. Inclusion criteria were children younger than 5 years of age, a confirmed diagnosis of nonaccidental trauma, and cervical spine MR imaging within 1 week of presentation. Brain and cervical spine MR imaging, head CT, cervical radiographs, and skeletal surveys were reviewed.
  
  
  RESULTS
  There were 89 patients included in this study (48 males; mean age, 9.1 months [range, 1-59 months]). Cervical spine injury on MR imaging was found in 61 patients (69%). Ligamentous injury was seen in 60 patients (67%), with interspinous ligaments being most commonly involved. Abnormal capsular fluid (atlanto-occipital and atlantoaxial) was present in 28 patients (32%). Cervical spine injury on MR imaging was significantly associated with parenchymal restricted diffusion on brain MR imaging and parenchymal injury on head CT (P= .0004 andP= .0104, respectively). Children with restricted diffusion on brain MR imaging were 6.22 (point estimate) times more likely to have cervical spine injury on MR imaging.
  
  
  CONCLUSIONS
  There is a high incidence of cervical spine injury in pediatric nonaccidental trauma. Positive findings may affect management and suggest a traumatic etiology.
authors.affiliation: From the Departments of Radiology (R.J., K.K., Y.X., T.N.B.).
authors.forename: R
authors.identifier: http://orcid.org/0000-0003-4599-2894
authors.initials: R
authors.lastname: Jacob
authors.affiliation: Pediatrics (M.C., K.R., B.W., R.H.).
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-6589-5376
authors.initials: M
authors.lastname: Cox
authors.affiliation: From the Departments of Radiology (R.J., K.K., Y.X., T.N.B.).
authors.forename: K
authors.identifier: http://orcid.org/0000-0002-8695-300X
authors.initials: K
authors.lastname: Koral
authors.affiliation: Pediatric Surgery (C.G., L.V.).
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-4822-2211
authors.initials: C
authors.lastname: Greenwell
authors.affiliation: From the Departments of Radiology (R.J., K.K., Y.X., T.N.B.).
authors.forename: Y
authors.identifier: http://orcid.org/0000-0001-9743-3010
authors.initials: Y
authors.lastname: Xi
authors.affiliation: Pediatric Surgery (C.G., L.V.).
authors.forename: L
authors.identifier: http://orcid.org/0000-0002-8902-0600
authors.initials: L
authors.lastname: Vinson
authors.affiliation: Pediatrics (M.C., K.R., B.W., R.H.).
authors.forename: K
authors.identifier: http://orcid.org/0000-0002-2795-7967
authors.initials: K
authors.lastname: Reeder
authors.affiliation: Pediatrics (M.C., K.R., B.W., R.H.).|Neurological Surgery (B.W.), Children's Health, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: B
authors.identifier: http://orcid.org/0000-0003-4466-4549
authors.initials: B
authors.lastname: Weprin
authors.affiliation: Pediatrics (M.C., K.R., B.W., R.H.).
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-5385-921X
authors.initials: R
authors.lastname: Huang
authors.affiliation: From the Departments of Radiology (R.J., K.K., Y.X., T.N.B.) tim.booth@childrens.com.
authors.forename: T N
authors.identifier: http://orcid.org/0000-0003-0757-0957
authors.initials: TN
authors.lastname: Booth