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MRI in Cervical Fractures

- See:
  - MRI Spine: Discussion;
  -
Role of CT in C-spine Injuries:

- Discussion:
    - for visualizing soft tissue and neural elements, & unsuspected disc herniations in presence of cercial spine fractures;
    -
disc herniation may indicate disruption of anterior or posterior longitudinal ligament;
         - MRI is useful when traumatic disk herniation may accompany an injury;
    - differentiates cord edema from hemorrhage or vascular infarction;
    - is useful for delineating
SCIWORA syndrome;
    - for visualizing widening of the interspinous, interlaminar, or facet distances,
prevertebral soft tissue prominence
    - in pts w/ neurologic deficit - differentiate a compressive, extradural lesion from an intramedullary lesion injury;
    - epidural hematoma:
         - has a characteristic signal intensity, depending on age of the injury;
         - is not centered at the disc space;
         - preop knowledge of such space occupying compressive lesions is essential in pts who are considered for surgery;
         - intramedullary lesion, such as cord contussion, can be differentiated from hematoma on basis of signal characteristics obtained on both T1 and T2 weighted images;
         - intramedullary hematoma has mixed signal on short TR (T1) images & displays central low intensity surrounded by high intensity on long TR (T2) images;
         - cord edema has normal T1 intensity, & is homogenously hyperintense on long TR (T2) images;

- Contraindications:
    - pts w/ pacemaker, aneurysm clips, metallic fragments in eye or spinal cord, or severe claustrophobia


References 

Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation.

Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient.  

Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury: MRI for the evaluation of patients with occult cervical spine injury

Acute cervical cord injury without fracture or dislocation of the spinal column