It appears that MRI scans provide more accurate imaging than X-rays for children with certain types of neck injuries. New research from the Monash Medical Centre in Melbourne, Australia suggests that X-ray imaging is more likely to miss low-impact neck injuries in children, while also showing abnormalities that MRI scans later cleared.
And while doctors weigh the radiation exposure against the benefit of a diagnostic image before ordering any X-ray, the radiation is not why MRI scans now appear preferable, at least in this small population of pediatric neck injury.
The team of researchers that produced these findings had a ready data-stream at their disposal: patient records from their own hospital. They conducted a lengthy review of all cases in which pediatric patients visited the Monash Medical Centre from July 2011 to June 2015, complaining of neck injuries (not counting cases of “high-impact trauma,” which would presumably be much more serious). Then the researchers studied the imaging modalities that radiologists used in those cases.
Measuring the Benefits of MRI Scans vs. X-Rays in Pediatric Cases of Neck Trauma
Of the 47 patients who met the criteria for inclusion in the study, a full 46 received a specific type of X-ray procedure called cervical spine series radiography, or a CSS radiograph. Some of the patients had multiple imaging procedures, which is why it’s possible that 34 of them received an MRI scan and nine got CT scans.
Armed with the images and the outcomes, researchers searched to see what worked. They found that the MRI scans uncovered four injuries that the X-rays missed. There were also two cases in which X-rays appeared abnormal, while MRI images later cleared the patients.
The authors of the study, which was published in the Feb. 2017 issue of the journal Child’s Nervous System, write that, “In this study, MRI has a greater sensitivity and specificity when compared to CSS radiography in a symptomatic pediatric low-impact trauma population.”
Sensitivity and Specificity in Diagnostic Testing
In medical literature, the “sensitivity” of a given test is a measurement of positive accuracy; if a test finds 80 percent of patients to have a condition, and all 80 percent actually do have that condition, then it is said to be highly “sensitive.”
“Specificity,” meanwhile, measures accuracy on the negative side. If a test finds that 20 percent of patients do not have a given condition, and, in fact, none of them do, that’s a very “specific” test. Both terms work together to describe the accuracy of a diagnostic procedure.
So when the researchers say that MRI scans are both more sensitive and specific than X-ray examinations for a particular subset of trauma patients, that’s a strong recommendation of the former imaging modality versus the latter.
“Our data call into question the routine use of CSS radiographs in children,” the researchers conclude.
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Baratloo, Alireza, Mostafa Hosseini, Ahmed Negida, and Gehad El Ashal. “Part 1: Simple Definition and Calculation of Accuracy, Sensitivity, and Specificity.” PubMed. Emergency, 2015. Web. 15 Sept. 2017.
Moore, Justin, Jonathan Hall, Michael Ditchfield, Christopher Xenos, and Andrew Danks. “Utility of plain radiographs and MRI in cervical spine clearance in symptomatic non-obtunded pediatric patients without high-impact trauma.” Springer. Child’s Nervous System, Feb. 2017. Web. 15 Sept. 2017.