Diagnostic value of prevertebral high-signal width on T2-weighted MRI in cervical hyperex-tension injuries

Liang Haibo; Xu Hongming; Jin Haiming; Wang Xiangyang

doi:10.3969/j.issn.1009-4237.2026.02.003

Abstract：Objective To compare the early prevertebral soft tissue high-signal width on T2-weighted MRI between healthy controls and patients with cervical hyperextension injuries,and to evaluate its diagnostic value.Methods A retrospective analysis was performed on 198 individuals who underwent cervical MRI at the Second Af-filiated Hospital of Wenzhou Medical University between Sep.2020 and Sep.2024 due to cervical hyperextension injury or routine health examination.The control group consisted of 116 healthy volunteers with no remarkable ab-normalities on cervical MRI,while the patient group included 82 patients with a definite history of cervical hyperex-tension injury whose MRI findings were consistent with hyperextension-related imaging features.The prevertebral high-signal width at the C1-C7 levels on mid-sagittal T2-weighted images was measured and compared between the two groups.Receiver operating characteristic(ROC)curve analysis was used to assess the diagnostic performance of each cervical level and the maximum width,and optimal cutoff values were determined.Correlations between the prevertebral high-signal width and the level of spinal cord and intervertebral disc injuries were also analyzed.Results The median(P25,P75)prevertebral high-signal width was 1.28(1.01-1.60)mm in the control group and 2.23(1.53-4.47)mm in the patient group.The prevertebral high-signal width at the C1-C5 levels was significantly grea-ter in the patient group than in the control group(all P＜0.05).The area under the ROC curve(AUC)for each level from C1-C5 exceeded 0.9,with the highest value observed at the C3 level(AUC=0.988;cutoff value:2.155 mm;sensitivity:96.3%;specificity:94.0%).The AUC for the"maximum width"across the C1-C5 levels was 0.991,with an optimal cutoff value of 2.91 mm(sensitivity:95.1%;specificity:96.6%).No significant cor-relations were identified between the prevertebral high-signal width and the level of spinal cord injuries(r=-0.049,P=0.521)or intervertebral disc injury(r=-0.075,P=0.408).Conclusion Prevertebral soft tissue high-signal width on T2-weighted MRI demonstrates high diagnostic performance for cervical hyperextension injuries at the C1-C5 levels,with the optimal performance at the C3 level.Among these parameters,the"maximum width"across C1-C5 shows the greatest stability and may serve as a valuable quantitative indicator for early MRI identification of cervical hyperextension injuries.