Panel on Neurological Imaging and

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.

[1]  S. Milla,et al.  ACR Appropriateness Criteria® Suspected Spine Trauma-Child. , 2019, Journal of the American College of Radiology : JACR.

[2]  H. Hey,et al.  The utility of magnetic resonance imaging in addition to computed tomography scans in the evaluation of cervical spine injuries: a study of obtunded blunt trauma patients , 2018, European Spine Journal.

[3]  R. D. de Bie,et al.  To What Degree Does Active Cervical Range of Motion Differ Between Patients With Neck Pain, Patients With Whiplash, and Those Without Neck Pain? A Systematic Review and Meta-Analysis. , 2017, Archives of physical medicine and rehabilitation.

[4]  Kathryn L. Butler,et al.  Cervical spine MRI in patients with negative CT: A prospective, multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT) , 2017, The journal of trauma and acute care surgery.

[5]  A. Flanders,et al.  Imaging of the thoracic and lumbar spine in a high volume level 1 trauma center: are reformatted images of the spine essential for screening in blunt trauma? , 2017, Emergency Radiology.

[6]  E. Moore,et al.  Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. , 2016, American journal of surgery.

[7]  Y. Katsuura,et al.  The epidemiology of thoracolumbar trauma: A meta-analysis. , 2016, Journal of orthopaedics.

[8]  Julie A. Dunn,et al.  Cervical spinal clearance: A prospective Western Trauma Association Multi-institutional Trial , 2016, Journal of Trauma and Acute Care Surgery.

[9]  Yogesh Kumar,et al.  Role of magnetic resonance imaging in acute spinal trauma: a pictorial review , 2016, BMC Musculoskeletal Disorders.

[10]  H. Forman,et al.  Comparison of CT and MRI findings for cervical spine clearance in obtunded patients without high impact trauma , 2016, Clinical neurology and neurosurgery (Dutch-Flemish ed. Print).

[11]  K. Hamden,et al.  Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients , 2016, The western journal of emergency medicine.

[12]  R. Gonzalez,et al.  Thoracolumbar spine clearance: Clinical examination for patients with distracting injuries , 2016, The journal of trauma and acute care surgery.

[13]  D. Unwin,et al.  Falls and Implementation of NEXUS in the Elderly (The FINE Study). , 2015, The Journal of emergency medicine.

[14]  G. Velmahos,et al.  Additional Imaging in Alert Trauma Patients with Cervical Spine Tenderness and a Negative Computed Tomographic Scan: Is it Needed? , 2015, World Journal of Surgery.

[15]  J. Como,et al.  Adjacent Level Ligamentous Injury Associated with Traumatic Cervical Spine Fractures: Indications for Imaging and Implications for Treatment. , 2015, World Neurosurgery.

[16]  P. Ben-Galim,et al.  Efficacy of MRI for Assessment of Spinal Trauma: Correlation With Intraoperative Findings , 2015, Journal of spinal disorders & techniques.

[17]  Alexander L. Eastman,et al.  Clinical and radiographic outcomes following traumatic Grade 3 and 4 carotid artery injuries: a 10-year retrospective analysis from a Level 1 trauma center. The Parkland Carotid and Vertebral Artery Injury Survey. , 2015, Journal of neurosurgery.

[18]  K. Inaba,et al.  Prospective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma: An American Association for the Surgery of Trauma Multi-Institutional Trials Group Study , 2015, The journal of trauma and acute care surgery.

[19]  Joel D Stitzel,et al.  Has the Incidence of Thoracolumbar Spine Injuries Increased in the United States From 1998 to 2011? , 2015, Clinical orthopaedics and related research.

[20]  C. Oppenheim,et al.  CONTINUING EDUCATION PROGRAM : FOCUS . . . Imaging of cervical artery dissection , 2014 .

[21]  M. Nies,et al.  Cervical Spine Computed Tomography Imaging Artifact Affecting Clinical Decision-Making in the Traumatized Patient , 2014, The open orthopaedics journal.

[22]  K. Inaba,et al.  Clinical relevance of magnetic resonance imaging in cervical spine clearance: a prospective study. , 2014, JAMA surgery.

[23]  Alpesh A. Patel,et al.  Clinical results of patients with subaxial cervical spine trauma treated according to the SLIC score , 2014, The journal of spinal cord medicine.

[24]  R. Marshall,et al.  Denver screening protocol for blunt cerebrovascular injury reduces the use of multi‐detector computed tomography angiography , 2014, ANZ journal of surgery.

[25]  T. Sundstrøm,et al.  Prehospital use of cervical collars in trauma patients: a critical review. , 2014, Journal of neurotrauma.

[26]  C. Truwit,et al.  Screening and detection of blunt vertebral artery injury in patients with upper cervical fractures: the role of cervical CT and CT angiography. , 2014, European journal of radiology.

[27]  Ben L Zarzaur,et al.  Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: More slices finally cut it , 2014, The journal of trauma and acute care surgery.

[28]  L. Wolfe,et al.  Evaluation of Cervical Spine Fracture in the Elderly: Can We Trust Our Physical Examination? , 2014, The American surgeon.

[29]  M. Bernstein,et al.  The (f)utility of flexion-extension C-spine films in the setting of trauma. , 2013, American journal of surgery.

[30]  R. Daffner,et al.  Cervical spine clearance in the traumatically injured patient: is multidetector CT scanning sufficient alone? Clinical article. , 2013, Journal of neurosurgery. Spine.

[31]  J. Saxe,et al.  Are flexion extension films necessary for cervical spine clearance in patients with neck pain after negative cervical CT scan? , 2013, The Journal of surgical research.

[32]  B. Schoennagel,et al.  Fractures of the thoracic spine in patients with minor trauma: comparison of diagnostic accuracy and dose of biplane radiography and MDCT. , 2013, European journal of radiology.

[33]  G. Velmahos,et al.  Vertebral Artery Injury Associated With Blunt Cervical Spine Trauma: A Multivariate Regression Analysis , 2013, Spine.

[34]  N. Martin,et al.  Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma , 2013, The journal of trauma and acute care surgery.

[35]  Y. Toyama,et al.  Modic changes of the cervical spine in patients with whiplash injury: a prospective 11-year follow-up study. , 2013, Injury.

[36]  L. Wolfe,et al.  CT for all or selective approach? Who really needs a cervical spine CT after blunt trauma , 2013, The journal of trauma and acute care surgery.

[37]  R. Jain,et al.  Screening Cervical Spine CT in the Emergency Department, Phase 2: A Prospective Assessment of Use , 2013, American Journal of Neuroradiology.

[38]  E. Klineberg,et al.  Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients , 2013, European Spine Journal.

[39]  A. Verhagen,et al.  Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review , 2012, Canadian Medical Association Journal.

[40]  C. Heal,et al.  Adherence to Canadian C‐Spine Rule in a regional hospital: A retrospective study of 406 cases , 2012, Journal of medical imaging and radiation oncology.

[41]  D. Chung,et al.  Vertebral artery injury in destabilized midcervical spine trauma; predisposing factors and proposed mechanism , 2012, Acta Neurochirurgica.

[42]  M. Venkatesan,et al.  CT scanning reduces the risk of missing a fracture of the thoracolumbar spine. , 2012, The Journal of bone and joint surgery. British volume.

[43]  Y. Toyama,et al.  Cross-sectional area of the posterior extensor muscles of the cervical spine in whiplash injury patients versus healthy volunteers--10 year follow-up MR study. , 2012, Injury.

[44]  Khoi D. Than,et al.  Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury , 2012, The journal of trauma and acute care surgery.

[45]  Manzar Hussain,et al.  Flexion/extension cervical spine views in blunt cervical trauma. , 2012, Chinese journal of traumatology = Zhonghua chuang shang za zhi.

[46]  L. Holly,et al.  ACR Appropriateness Criteria(®) myelopathy. , 2012, Journal of the American College of Radiology : JACR.

[47]  O. Bouamra,et al.  Epidemiology and predictors of cervical spine injury in adult major trauma patients: A multicenter cohort study , 2012, The journal of trauma and acute care surgery.

[48]  D. Wisner,et al.  The value of cervical magnetic resonance imaging in the evaluation of the obtunded or comatose patient with cervical trauma, no other abnormal neurological findings, and a normal cervical computed tomography , 2012, The journal of trauma and acute care surgery.

[49]  M. McGirt,et al.  Clinical Indications for Arterial Imaging in Cervical Trauma , 2012, Spine.

[50]  E. Moore,et al.  Blunt cerebrovascular injuries: Redefining screening criteria in the era of noninvasive diagnosis , 2012, The journal of trauma and acute care surgery.

[51]  C. Boesch,et al.  Are there cervical spine findings at MR imaging that are specific to acute symptomatic whiplash injury? A prospective controlled study with four experienced blinded readers. , 2012, Radiology.

[52]  A. Espeland,et al.  Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury: A Prospective Controlled Study , 2011, American Journal of Neuroradiology.

[53]  D. Okonkwo,et al.  Comparative effectiveness of using computed tomography alone to exclude cervical spine injuries in obtunded or intubated patients: meta-analysis of 14,327 patients with blunt trauma. , 2011, Journal of neurosurgery.

[54]  J. Grauer,et al.  The Incidence of Noncontiguous Spinal Fractures and Other Traumatic Injuries Associated With Cervical Spine Fractures: A 10-Year Experience at an Academic Medical Center , 2011, Spine.

[55]  J. Whelan,et al.  Canadian Cervical Spine rule compared with computed tomography: a prospective analysis. , 2011, The Journal of trauma.

[56]  J. Marcoux,et al.  The role of magnetic resonance imaging in the management of acute spinal cord injury. , 2011, Journal of neurotrauma.

[57]  S. Lydersen,et al.  Clinical Characteristics, Pain, and Disability in Relation to Alar Ligament MRI Findings , 2011, Spine.

[58]  Safdar N. Khan,et al.  Use of Flexion and Extension Radiographs of the Cervical Spine to Rule Out Acute Instability in Patients With Negative Computed Tomography Scans , 2011, Journal of orthopaedic trauma.

[59]  J. Cross,et al.  Do Flexion Extension Plain Films Facilitate Treatment after Trauma? , 2010, The American surgeon.

[60]  Ian Stiell,et al.  Validation of the Canadian c-spine rule in the UK emergency department setting , 2010, Emergency Medicine Journal.

[61]  R. Teasell,et al.  A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 2 - interventions for acute WAD. , 2010, Pain research & management.

[62]  Matthew Meyer,et al.  A research synthesis of therapeutic interventions for whiplash-associated disorder: part 1 - overview and summary. , 2010, Pain research & management.

[63]  R. Teasell,et al.  A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 4 - noninvasive interventions for chronic WAD. , 2010, Pain research & management.

[64]  Y. Toyama,et al.  Prospective Ten-Year Follow-up Study Comparing Patients With Whiplash-Associated Disorders and Asymptomatic Subjects Using Magnetic Resonance Imaging , 2010, Spine.

[65]  Jin-Suck Suh,et al.  A comparison of the diagnostic performances of visceral organ-targeted versus spine-targeted protocols for the evaluation of spinal fractures using sixteen-channel multidetector row computed tomography: is additional spine-targeted computed tomography necessary to evaluate thoracolumbar spinal fract , 2010, The Journal of trauma.

[66]  J. Cross,et al.  Flexion-Extension Cervical Spine Plain Films Compared with MRI in the Diagnosis of Ligamentous Injury , 2010, The American surgeon.

[67]  A. Server,et al.  Magnetic resonance imaging of ligaments and membranes in the craniocervical junction in whiplash-associated injury and in healthy control subjects , 2010, Acta radiologica.

[68]  T. Scalea,et al.  40-Slice Multidetector CT: Is MRI Still Necessary for Cervical Spine Clearance after Blunt Trauma? , 2010, The American surgeon.

[69]  Y. Toyama,et al.  Longitudinal magnetic resonance imaging study on whiplash injury patients: minimum 10-year follow-up , 2009, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[70]  G. Galloway,et al.  The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation , 2009, European Spine Journal.

[71]  K. Nagy,et al.  CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. , 2009, The Journal of trauma.

[72]  A. Espeland,et al.  MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1–2: high-signal changes by age, gender, event and time since trauma , 2009, Neuroradiology.

[73]  A. Vasavada,et al.  The Anatomy and Biomechanics of Acute and Chronic Whiplash Injury , 2009, Traffic injury prevention.

[74]  Wensheng Guo,et al.  Prevalence of cervical spinal injury in trauma. , 2008, Neurosurgical focus.

[75]  Parimal Mukhopadhyay,et al.  Multivariate Regression Analysis , 2008 .

[76]  G. Zaharchuk,et al.  Comparison of Multidetector CT Angiography and MR Imaging of Cervical Artery Dissection , 2008, American Journal of Neuroradiology.

[77]  J. Zwart,et al.  Magnetic Resonance Imaging Assessment of the Alar Ligaments in Whiplash Injuries: A Case-Control Study , 2008, Spine.

[78]  T. Bendix,et al.  Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up , 2008, European Spine Journal.

[79]  A. Peitzman,et al.  MRI is unnecessary to clear the cervical spine in obtunded/comatose trauma patients: the four-year experience of a level I trauma center. , 2008, The Journal of trauma.

[80]  T. Scalea,et al.  Computed tomography alone for cervical spine clearance in the unreliable patient--are we there yet? , 2008, The Journal of trauma.

[81]  B. Aarabi,et al.  The Subaxial Cervical Spine Injury Classification System: A Novel Approach to Recognize the Importance of Morphology, Neurology, and Integrity of the Disco-Ligamentous Complex , 2007, Spine.

[82]  H. Stelfox,et al.  Computed tomography for early and safe discontinuation of cervical spine immobilization in obtunded multiply injured patients. , 2007, The Journal of trauma.

[83]  James S. Anderson,et al.  Is magnetic resonance imaging essential in clearing the cervical spine in obtunded patients with blunt trauma? , 2007, The Journal of trauma.

[84]  J. Kråkenes,et al.  Magnetic Resonance Imaging Assessment of Craniovertebral Ligaments and Membranes After Whiplash Trauma , 2006, Spine.

[85]  T. Egglin,et al.  Sixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries. , 2006, The Journal of trauma.

[86]  Stephen Cohn,et al.  Visceral torso computed tomography for clearance of the thoracolumbar spine in trauma: a review of the literature. , 2006, The Journal of trauma.

[87]  J. Rosenfeld,et al.  Cervical spine clearance in unconscious traumatic brain injury patients: dynamic flexion-extension fluoroscopy versus computed tomography with three-dimensional reconstruction. , 2006, The Journal of trauma.

[88]  Oscar D. Guillamondegui,et al.  The early work-up for isolated ligamentous injury of the cervical spine: does computed tomography scan have a role? , 2005, The Journal of trauma.

[89]  Alexander L. Eastman,et al.  Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime? , 2005, The Journal of trauma.

[90]  G. Albrektsen,et al.  Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. , 2005, Journal of neurotrauma.

[91]  C. Sliker,et al.  Assessing cervical spine stability in obtunded blunt trauma patients: review of medical literature. , 2005, Radiology.

[92]  E. Moore,et al.  Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. , 2004, Archives of surgery.

[93]  Brian H Rowe,et al.  The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. , 2003, The New England journal of medicine.

[94]  D. Hackney,et al.  Diffusion-weighted MRI and the evaluation of spinal cord axonal integrity following injury and treatment , 2003, Experimental Neurology.

[95]  E. Moore,et al.  Cervical spine fracture patterns predictive of blunt vertebral artery injury. , 2003, The Journal of trauma.

[96]  R. Sheridan,et al.  Reformatted visceral protocol helical computed tomographic scanning allows conventional radiographs of the thoracic and lumbar spine to be eliminated in the evaluation of blunt trauma patients. , 2003, The Journal of trauma.

[97]  R. Lavery,et al.  Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. , 2003, The Journal of trauma.

[98]  T. Joseph,et al.  Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. , 2003, Injury.

[99]  E. Moore,et al.  Noninvasive diagnosis of blunt cerebrovascular injuries: a preliminary report. , 2002, The Journal of trauma.

[100]  A Laupacis,et al.  The Canadian C-spine rule for radiography in alert and stable trauma patients. , 2001, JAMA.

[101]  R. Sheridan,et al.  Can chest and abdominal trauma CT eliminate the need for plain films of the spine? – Experience with 329 multiple trauma patients , 2001, Emergency Radiology.

[102]  Aurelio Rodríguez,et al.  Falls and major injuries are risk factors for thoracolumbar fractures: cognitive impairment and multiple injuries impede the detection of back pain and tenderness. , 1995, The Journal of trauma.

[103]  Suspected Spine Trauma , 2018 .

[104]  T. Esposito,et al.  Cervical spine clearance when unable to be cleared clinically: a pooled analysis of combined computed tomography and magnetic resonance imaging. , 2016, American journal of surgery.

[105]  K. Inaba,et al.  Clinical examination is insufficient to rule out thoracolumbar spine injuries. , 2011, The Journal of trauma.

[106]  Mitchel B Harris,et al.  Computed tomography alone versus computed tomography and magnetic resonance imaging in the identification of occult injuries to the cervical spine: a meta-analysis. , 2010, The Journal of trauma.

[107]  D. Resnick,et al.  Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis. , 2008, The Journal of trauma.

[108]  E. Panacek,et al.  Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. , 2003, The Journal of emergency medicine.

[109]  J. Anglen,et al.  Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma patients. , 2002, The Journal of trauma.

[110]  J R Hoffman,et al.  Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. , 2000, The New England journal of medicine.

[111]  P. Prandoni,et al.  A Case-Control Study , 2022 .