Absence of T2 flow voids in the vertebral arteries on cervical spine MRI in patients with trauma

Abstract

Purpose: To investigate patients with cervical spine trauma with absence of T2 flow voids in the vertebral arteries (VAs) on cervical spine MRI, assess the proportion of VA occlusion and subsequent brain infarction, and identify injury patterns associated with brain infarction.

Methods: Patients with absence of T2 flow voids in the VA on cervical spine MRI for acute trauma in a regional trauma center between 2019 and 2023 were retrospectively evaluated. Injury characteristics were assessed, and the absence of T2 flow voids, an indicator of VA injury and brain infarction, was confirmed by angiography and brain MRI. Univariate exact logistic regression was employed to evaluate the association of cervical spine injury characteristics with the presence of brain infarction in the VA territory.

Results: Of 683 patients, 42 (6.1 %) showed VA T2 flow void absence. The absence of T2 flow voids was predominantly unilateral (95.2 %). Coexisting transverse foramen fractures, discoligamentous complex (DLC) disruptions, and cord injuries were recorded in 61.9 %, 38.1 %, and 57.1 % of patients, respectively. Overall, 45.2 % and 26.2 % of patients had VA occlusion and brain infarction, respectively, with 14.3 % having both. Brain infarction was significantly associated with DLC disruptions (OR = 8.26, p = 0.040) and spinal cord injuries (OR = 12.09, p = 0.014). Two patients with bilateral VA involvement both developed brain infarction.

Conclusion: In patients with cervical spine trauma and an absence of T2 flow voids in the VAs on MRI, VA occlusion and subsequent brain infarction were frequently observed. Brain infarctionin these cases was associated with DLC disruptions or spinal cord injuries.

Keywords: Cervical spine MRI; Discoligamentous complex disruption; Spinal cord injury; T2 flow void; Vertebral artery injury.