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Background
Acute spinal cord injuries are common and can result in significant morbidity and mortality. It is well established that imaging plays a critical role in completing the evaluation of patients who have experienced acute spinal trauma. The workhorse of cervical spine trauma imaging is computed tomography (CT) which most radiologists are comfortable reading. However, magnetic resonance imaging (MRI) is becoming more commonly employed especially in the evaluation of ligamentous injury. Therefore, it is essential for radiologists to be comfortable with normal anatomy as well as pathology on cervical spine MRI. In this educational exhibit, we will consider the strengths of different imaging modalities, review MRI cervical spine anatomy, discuss the purposes of commonly used MRI sequences/imaging planes, and provide an approach to post-traumatic cervical spine MRI. This will be accomplished through cases demonstrating increasingly complex post-traumatic findings so that the viewer becomes more efficient and comfortable with acute cervical spine MRI.

Educational Goals / Teaching Points
Review the common steps in the workup of a patient with suspected acute cervical spine injury. Discuss the strengths, weaknesses and differences of CT and MRI with a focus on MRI. Provide a pictorial review of cervical spine anatomy on MRI, focusing on ligamentous and other soft tissue structures best assessed with MRI such as intervertebral discs, spinal cord, nerve roots, paraspinal muscle injuries, and epidural hemorrhage. Demonstrate the best sequences and views to evaluate these structures. Review some imaging pearls and pitfalls of traumatic cervical spine imaging. Finally, provide an approach to interpreting post-traumatic MRI.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Emphasize the importance of MRI in fully assessing the acute cervical spine to include the evaluation of stability and the presence of cord injury. Illustrate the anatomy of the cervical spine and discuss the important ligaments involved in stability. Demonstrate how combining CT and MRI findings provides a more complete evaluation of the spine in the setting of trauma. Enhance interpretation proficiency through familiarity with complex post traumatic cases.

Conclusion
Though CT and MRI play complimentary roles in the evaluation of acute cervical spine, MRI is more sensitive and can more accurately evaluate the extent of injury, particularly soft tissue structures. MRI also plays a critical role in predicting the prognosis of the patient by completing the evaluation for stability and determining the presence of cord edema or hemorrhage. It is critical that the radiologist be familiar with cervical spine MRI to improve proficiency and decrease misdiagnosis.