FIG 3.

Fracture-positive, radiologist false-negative, CNN false-negative case example. Axial (A), sagittal (B), and coronal (C) cervical spine CT images, and sagittal fat-saturated T2-weighted cervical spine MR image (D) demonstrate a minimally displaced C4 spinous process fracture. Red arrows demarcate fracture lines, the blue arrow demarcates prevertebral edema, and the orange arrow demarcates interspinous and supraspinous ligamentous injury. This case example illustrates a subtle fracture missed by both the radiologist and CNN that was identified in retrospect with the help of MR imaging because of the presence of secondary signs, such a prevertebral edema and ligamentous injury.