Utility of STIR MRI in pediatric cervical spine clearance after trauma

Clinical article

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Object

Although MRI with short-term T1 inversion recovery (STIR) sequencing has been widely adopted in the clearance of cervical spine in adults who have sustained trauma, its applicability for cervical spine clearance in pediatric trauma patients remains unclear. The authors sought to review a Level 1 trauma center's experience using MRI for posttraumatic evaluation of the cervical spine in pediatric patients.

Methods

A pediatric trauma database was retrospectively queried for patients who received an injury warranting radiographic imaging of the cervical spine and had a STIR-MRI sequence of the cervical spine performed within 48 hours of injury between 2002 and 2011. Demographic, radiographic, and outcome data were retrospectively collected through medical records.

Results

Seventy-three cases were included in the analysis. The mean duration of follow-up was 10 months (range 4 days–7 years). The mean age of the patients at the time of trauma evaluation was 8.3 ± 5.8 years, and 65% were male. The majority of patients were involved in a motor vehicle accident. In 70 cases, the results of MRI studies were negative, and the patients were cleared prior to discharge with no clinical suggestion of instability on follow-up. In 3 cases, the MRI studies had abnormal findings; 2 of these 3 patients were cleared with dynamic radiographs during the same admission. Only 1 patient had an unstable injury and required surgical stabilization. The sensitivity of STIR MRI to detect cervical instability was 100% with a specificity of 97%. The positive predictive value was 33% and the negative predictive value was 100%.

Conclusions

Although interpretation of our results are diminished by limitations of the study, in our series, STIR MRI in routine screening for pediatric cervical trauma had a high sensitivity and slightly lower specificity, but may have utility in future practices and should be considered for implementation into protocols.

Abbreviations used in this paper:GCS = Glasgow Coma Scale; MRI = magnetic resonance imaging (used in this study to refer specifically to STIR sequences); STIR = short T1 inversion recovery.

Article Information

Address correspondence to: Steven W. Hwang, M.D., 800 Washington Street, Boston, Massachusetts 02111. email: shwang@tuftsmedicalcenter.org.

Please include this information when citing this paper: published online May 3, 2013; DOI: 10.3171/2013.4.PEDS12477.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flow diagram illustrating the study cohort and excluded patients (gray shading).

  • View in gallery

    False-positive MRI in a 13-year-old involved in an MVA. A: Sagittal MRI STIR sequence showing hyperintensity of the occipitocervical interspinous ligament (white arrow) and soft tissue (dotted arrow). B and C: Dynamic radiographs showing normal physiological movement in extension (B) and flexion (C).

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