Correlation of MR Imaging Findings with Intraoperative Findings after Cervical Spine Trauma
D. Goradiaa,c,
K.F. Linnaua,c,
W.A. Cohena,c,
S. Mirzab,
D.K. Hallama,c and
C.C. Blackmorea,c
a Department of Radiology, Harborview Medical Center, Seattle, Wash
b Department of Orthopedic Surgery, Harborview Medical Center, Seattle, Wash
c Department of Radiology, University of Washington Medical Center, Seattle, Wash
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Fig 1. True-positive injuries to the ALL, disk, and PLL. Sagittal STIR image demonstrates disruption of the ALL (arrow), intervertebral disk, and PLL (arrowhead) at C6–7. Injuries were confirmed at surgery.
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Fig 2. True-positive injuries to the ALL, disk, and PLL. Sagittal fast spin-echo T2-weighted image shows elevation of the ALL (white arrow), disruption of the intervertebral disk, and elevation of the PLL at C4–5 (black arrow). Injuries were confirmed at surgery.
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Fig 3. True-positive ligamentum flavum and interspinous ligament injuries. Sagittal STIR image demonstrates complete disruption of the ligamentum flavum (arrow) and interspinous ligament complex (paired small arrows) at C6–7, which was confirmed at surgery.
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Fig 4. True-positive facet fracture-dislocation. Parasagittal fast spin-echo T2 image shows a C6 facet fracture (arrowhead) with C6–7 facet dislocation (arrows), which were confirmed at surgery.
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Fig 5. Axial image of true-positive facet joint injury. Axial fast spin-echo T2-weighted image demonstrates widening of bilateral facet joints, more so on the right. Both facet capsules were injured at surgery.
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Fig 6. False-negative ALL. Sagittal fast spin-echo T2-weighted image demonstrates widening of the intervertebral disk and disruption of the PLL at C5–6, which were confirmed at surgery. The ALL, however, appears intact on the MR imaging but was found injured at surgery.
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Fig 7. False-positive ALL and disk and true-positive PLL injury manifesting as high T2 signal intensity. On this sagittal fast spin-echo T2-weighted image, there is high signal intensity along the PLL (arrow) manifesting as interruption of the normal dark linear PLL at C5–6. At the same level, the ALL appears disrupted and the disk appears widened compared with the level above, especially anteriorly. However, at surgery only the PLL was found injured and the disk and ALL were intact.
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Fig 8. True-positive ligamentum flavum and false-positive interspinous soft tissues. Sagittal STIR image demonstrates disruption of the ligamentum flavum at multiple levels. Injury at the operative level C3–4 (arrow) was confirmed at surgery. On the image, there is also increased T2 signal intensity with stretching of the interspinous ligamentous complex; however, at surgery, this complex was intact.
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Fig 9. False-negative ligamentum flavum and true-positive interspinous soft tissue injury. Sagittal T2-weighted image shows spinous process fractures of C7 and T1 (arrows). There is increased T2 signal intensity and stretching of the interspinous ligament complex (injury confirmed at surgery). The ligamentum flavum at the level of injury appears intact on the MR imaging but was found to be injured at surgery.
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