Slavin J, Beaty N, Raghavan P, Sansur C, Aarabi B. World Neurosurg. 2015; 84(6): 1916-1922.
Affiliation
University of Maryland, Department of Neurosurgery, 22 South Greene St., Suite S-12-D, Baltimore, MD 21201. Electronic address: baarabi@smail.umaryland.edu.
BACKGROUND AND PURPOSE: Patients presenting with gunshot wounds (GSWs) to the neck are difficult to assess due to often severe injuries that are incompletely evaluated by CT alone. Our institution treats hundreds of GSW patients each year and we present our experience using MRI in the evaluation of cervical GSWs.
MATERIALS AND METHODS: From August 2000 to July 2012 all GSWs to the cervical spine treated at our institution were cataloged. Seventeen patients had one or more MRI studies of the cervical spine. Informed consent was obtained prior to MRI indicating the risks of retained metal fragments in the setting of high magnetic fields. CT scans were obtained before and after MRI to document any possible migration of metal fragments. We documented patients' neurologic examination results before and after MRI and at follow up.
RESULTS: Patients' age range was 18 to 56 (mean 29.8). Eleven of 17 patients had retained metal fragments seen on CT scan including 3 patients with fragments within the spinal canal. No patient experienced a decline in neurologic function after MRI. No migration of retained fragments was observed. Fifteen of 17 patients returned for follow up examinations, with an average follow up interval of 39.1 weeks (range: 1.3 to 202.3 weeks; median: 8 weeks).
CONCLUSION: For carefully selected patients, MRI can be an effective tool in assessing GSWs to the neck and it can significantly improve the evaluation and management of this cohort. No patient in our series suffered a complication related to MRI.