ABSTRACT
Limited flip angle (LFA), gradient echo imaging was performed in 130 patients for evaluation of cervical radicular complaints. The LFA study was compared with myelography, CT myelography, and surgical results. Image quality was considered good or excellent for 128 patients. The use of a 10 degrees flip angle with a TR of 75 msec and TE of 12.3 msec consistently provided good contrast and signal-to-noise ratio, giving a CT myelographic effect. The use of both axial and sagittal LFA images was important for optimal detection of extradural defects and for distinction of herniated disk versus osteophyte. There was excellent correlation between the MR and surgical findings. Our results suggest that MR imaging is the initial procedure of choice for the evaluation of suspected cervical radiculopathy.
Subject(s)
Cervical Vertebrae/pathology , Magnetic Resonance Imaging , Spinal Nerve Roots/pathology , Cervical Vertebrae/diagnostic imaging , Humans , Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/diagnostic imaging , Magnetic Resonance Imaging/methods , Myelography , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/diagnostic imaging , Spinal Nerve Roots/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
All trauma patients undergoing cervical radiography at an urban referral teaching hospital emergency department during 12 consecutive months were analyzed for indications and results of cervical spine radiograph studies. Demographic characteristics of the study group were consistent with results in the literature (55% men, mean age, 27). Cases were reviewed for 27 commonly accepted indications in the literature for cervical spine studies under these circumstances. The following radiograph findings were considered as positive studies: fracture, subluxation, spondylolisthesis, straightening, spasm, foreign body, compression, fusion, narrowing, or soft tissue swelling. Seventeen percent of radiographs were positive. Motor vehicle accidents (P less than .009), a history of direct cervical trauma (P less than .002), loss of consciousness (P less than .001), cervical tenderness (P less than .05), and drug ingestion (P less than .08) were associated with or suggestive of positive radiographs. No patients wearing seatbelts had positive radiographs (P less than .001). Only 2.4% (18 of 749) of radiographic examinations revealed clinically significant findings, and no criteria were statistically correlated with clinically significant findings. While our study suggests up to two-thirds of radiographs might be deferred without missing a clinically significant injury using these high-yield criteria, a flexible approach to cervical roentgenographs is justified pending confirmation of our results by a large, multicenter, prospective study currently under way.
