MRI gives pediatric trauma docs more to go on than x-ray series

Children presenting with symptoms of low-impact neck trauma are better imaged with MRI than with x-ray—and not just because of the radiation avoidance, according to a study published online Dec. 6 in Child’s Nervous System, the journal of the International Society for Pediatric Neurosurgery.

The advanced-imaging option bested cervical spine series (CSS) radiography at both sensitivity and specificity in the Australian research project, which was conducted at Monash University in Melbourne.

Justin Moore, MD, PhD, and colleagues reviewed the cases of several dozen patients aged 18 and younger who were admitted to Monash Medical Centre between July 2011 and June 2015.

The team concentrated on children who did not suffer a high-impact trauma but were symptomatic for cervical spine injury following cervical trauma.

They looked at the cases of 46 children who underwent CSS plain radiograph imaging, 34 who underwent MRI and nine who underwent CT.

Moore and colleagues found that MRI was able to detect four cases of ligament injury that were not seen in CSS imaging.

MRI was also able to facilitate cervical spine clearance in two patients whose CSS radiographs were abnormal.

“Our data call into question the routine use of CSS radiographs in children,” the authors conclude.

By way of contextualizing the study, Moore et al. note that the optimal imaging modality for evaluating children for cervical spine trauma is controversial.

“In pediatric populations, there are no well-established guidelines for cervical spine trauma evaluation and treatment,” they write. “Currently, there is virtually no literature regarding imaging and management of symptomatic pediatric patients who present with cervical spine trauma without high-impact mechanism.”

The authors express their hope that the present study helps establish an optimal imaging strategy for this subgroup of trauma patients.