Should the priority examination in spinal trauma be magnetic resonance imaging or computed tomography?

Abstract

Aim: To determine how to use magnetic resonance imaging (MRI)  and computed tomography  (CT), which are diagnostic methods, most efficiently for the rapid and accurate diagnosis of spinal trauma in trauma patients who apply to the emergency department.

Methods: For this purpose, 118 patients who apply to the emergency department and the neurosurgery outpatient clinic due to multiple trauma were scanned, retrospectively. The patient's history, MRI, CT and plain radiographs were evaluated in parallel with the patient's clinical findings. Descriptive statistical analysis of MRI and CT findings were performed and the findings were compared.

Results: In the present study, 33.9% of the patients were women and 66.1% were men. In our study, no fracture was detected in the CT or MRI images of 9% of the patients who suffered trauma. We found that 91% of vertebral fractures were missed in the evaluation based on clinical history and CT results. Later, with the MRI taken, the most fractures in women were detected in the 12th thoracic vertebra. In men, the most trauma was detected in the first lumbar vertebra. MRI examination revealed fractures in all patients. Therefore, detection of vertebral injuries missed by CT with MRI is of great importance in terms of spinal cord injuries. It was found statistically significant that vertebral injury detection was higher in the MRI system than in CT (p<0.05).

Conclusion: It is vital that every patient admitted to the hospital due to spinal trauma be scanned with an MRI- Short tau inversion recovery (STIR) sequence as the initial examination of the entire spine, and once the affected area is identified, the area or areas should be re-evaluated with CT. A screening should be performed and then the treatment method should be defined.