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Cervical Spine: Postmortem Assessment of Accident Injuries—Comparison of Radiographic, MR Imaging, Anatomic, and Pathologic Findings¹

¹ From the Department of Clinical Radiology (A.S., J.E., M.R.) and Clinic of Internal Medicine III (R.B.), University Hospital Ludwig-Maximilians-University Munich, Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Institute of Legal Medicine (R.P.) and Institute of Anatomy (S.P.M.), Ludwig-Maximilians-University Munich, Germany; and Department of Radiology, Veterans Administration Medical Center, San Diego, Calif (D.R.). Received January 24, 2001; revision requested February 21; revision received May 7; accepted May 21. Address correspondence to A.S. (e-mail: axel.staebler@ikra.med.uni-muenchen.de).

PURPOSE: To assess the ability of postmortem radiography and magnetic resonance (MR) imaging to depict occult cervical spine injuries as compared with anatomic and pathologic findings.

MATERIALS AND METHODS: The cervical spines of 10 adult accident victims underwent radiography and MR imaging, with T1-weighted, fast spin-echo T2-weighted, and four gradient-echo pulse sequences. The frozen specimens were cut into 3-mm-thick slices (sagittal plane) and photographed, and microfocus radiographs were obtained. Imaging findings were compared with the anatomic and pathologic findings.

RESULTS: Eight of the 10 specimens had 28 posttraumatic lesions: three fractures (two missed at the initial MR imaging reading), 10 facet joint capsule lesions with bleeding, five soft-tissue and ligament lesions, eight disk lesions, and two spinal cord lesions. Radiography depicted one lesion (4%). Two partial ruptures of the anterior annulus fibrosus were depicted at only MR imaging. Initially, 11 of 28 lesions were detected on MR images; retrospectively, 17 of 28 lesions were correlated with anatomic findings.

CONCLUSION: Soft-tissue and intervertebral disk and ligament injuries account for 89% (25 of 28) of posttraumatic cervical spine lesions detected on postmortem images. Occult lesions, including apophyseal joint injuries, were found in clinically noninjured cervical spines. MR imaging was limited in the depiction of discrete lesions when T1-weighted non–fat-saturated, fast spin-echo T2-weighted, and gradient-echo pulse sequences were used.

Index terms: Magnetic resonance (MR), comparative studies, 31.121411, 31.121412 • Spinal cord, injuries, 341.41, 341.42, 341.43 • Spine, injuries, 31.41, 34.42, 34.43 • Spine, radiography, 31.11 • Trauma, 31.40

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