Magnetic resonance imaging

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In patients with acute neck pain, but with no clinical indicators of any serious cause, magnetic resonance imaging (MRI) offers little prospect of a positive diagnosis. The only indication for MRI is as a screening test for rare and clinically occult disorders in patients with persistent or chronic neck pain. Yet even in that context, the use of MRI is questionable. By definition, rare conditions are unlikely to be evident, and in the absence of clinical indicators they are even more unlikely. The cardinal indicators are a past history of cancer, risk factors for infection, or signs of systemic illness. In patients with risk factors for aneurysm (see Chapter 12, Diagnostic procedures in chronic pain), magnetic resonance angiography is indicated.

In the absence of clinical indicators, MRI will reveal a normal cervical spine or normal age changes. Disk degeneration, disk bulges, spinal stenosis, and even spinal cord impingement occur in asymptomatic individuals, and with increasing frequency with age.74,75 Finding such abnormalities does not provide a diagnosis. In patients with neck pain after whiplash, multiple studies have shown that MRI reveals nothing but normal age changes, with the same prevalence as in the general population.76,

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