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MRI Is Nondiagnostic in Cervical Spine Imaging of the Helmeted Football Player with Shoulder Pads

Waninger, Kevin N. MD; Rothman, Michael MD; Heller, Michael MD

Clinical Journal of Sport Medicine: November 2003 - Volume 13 - Issue 6 - p 353-357
Brief Report

Background It is currently recommended that helmet and shoulder pads remain in place during the initial clinical and radiographic evaluation of the helmeted athlete with a potential cervical spine injury. The objective of this prospectively designed, single-subject study was to determine whether MRI may play a role in the initial evaluation and management of the helmeted football player with a cervical spine injury.

Methods One male athlete was fitted using equipment (football helmet [Riddell], shoulder pads [Douglas]) worn during the collegiate season at Lehigh University. Standard MRI using a routine clinical 0.7 T high field open MRI scanner (GE Signa System, Milwaukee, WI) was employed for the evaluation using standard clinical parameters (sagittal T1, fast spin echo [FSE] T2, STIR, and axial FSE T2 series). A single board-certified, fellowship-trained neuroradiologist reviewed all series. Studies were evaluated for image clarity and diagnostic capability in this clinical setting.

Results All standard MRI series were of extremely limited quality, even using sequences and slice selection designed to minimize artifact associated with metals (FSE T2-weighted series). When all MRI series were reviewed as a whole, sufficient evidence was not available to allow clinical decision making.

Conclusions The amount and type of metal within the standard football helmet and shoulder pads result in sufficient field inhomogeneity and SKEW artifact to preclude adequate evaluation of the cervical structures, rendering MRI evaluation in this setting not clinically useful. This study shows that current MRI techniques play no role in the clearance of the cervical spine (with currently available brands of helmet and shoulder pads in place) without prior equipment removal or manipulation.

From the Departments of Emergency Medicine (Drs Waninger and Heller) and Diagnostic Radiology (Dr Rothman), Saint Luke's Hospital, Bethlehem, PA, USA.

Received for publication November 2002; accepted July 2003.

Reprints: Kevin N. Waninger, MD, Department of Emergency Medicine, Saint Luke's Hospital, 211 North Barrington Court, Newark, DE 19702 (e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.