Role of Multidetector Computed Tomography in the Assessment of Cervical Spine Trauma

Objective To evaluate the accuracy of computed tomography (CT) in evaluation of patients with acute cervical spinal injury. Design Retrospective case series. Setting Three major public emergency departments in the southern hemisphere. Methods We performed a retrospective review of patients with neck injury aged at least 16, with CT cervical spine examinations performed for blunt trauma over a 6 month period (1 January 2011 to 30 June 2011) and magnetic resonance imaging (MRI) cervical spine performed for same indications over two and a half years (12 January 2010 to 22 June 2012). Results Acute cervical spine trauma was present on CT in 35 of 783 patients (4.5%) and on MRI in 98 of 206 patients (48%). Eleven of the 35 patients (31%) with CT confirmed trauma did not meet the Hanson criteria; the majority were at least 60 years of age and none had unstable injuries. CT is 100% sensitive in excluding an unstable injury if there is no soft tissue abnormality or fracture (with MRI as gold standard). An abnormal CT (including subtle paravertebral fat stranding) is often non-specific and often cannot reliably confirm an unstable ligamentous injury. Close attention to soft tissue axial and sagittal soft tissue CT reconstructions is important, as abnormalities can be subtle. Conclusions An unstable injury can often be excluded if CT is completely normal, without the need for MRI. (Hong Kong j.emerg.med. 2014;21:368-372)

Download Full-text

The role of magnetic resonance imaging in acute trauma of the cervical spine in children

Medical Visualization ◽

10.24835/1607-0763-2018-6-105-115 ◽

2019 ◽

Vol 22 (6) ◽

pp. 105-115

Author(s):

I. A. Korneev ◽

T. A. Akhadov ◽

I. A. Mel'nikov ◽

O. S. Iskhakov ◽

N. A. Semenova ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Cervical Spine ◽

Magnetic Resonance ◽

Diagnostic Method ◽

Cervical Spine Trauma ◽

Spine Trauma ◽

Resonance Imaging ◽

Acute Trauma

Aim.To evaluate the role of magnetic resonance imaging (MRI) as a diagnostic method in children with acute trauma of the cervical spine and spinal cord, to compare the correspondence of MRI results with neurologic symptoms in accordance with the ASIA scale.Materials and methods.156 children with acute trauma of spine and spinal cord at the age from 6 months up to 18 years were studied. MRI was performed on a Phillips Achieva 3T scanner. The standard protocol included MYUR (myelography) in coronal and sagittal projections, STIR and T2VI FS SE in sagittal projection, T2VI SE or T2 * VI FSGE (axial projection), 3D T1VI FSGE before and after contrast enhancement. Contrast substance was injected intravenously in the form of a bolus at the rate of 0.1 mmol/kg (equivalent to 0.1 ml/kg) at a rate of 3 to 4 ml.Results.The causes of cervical spine blunt trauma were: road accidents (55), catatrauma (60), “diver” trauma (21), blunt trauma (20). Intramedullary lesions of the spinal cord were detected: concussion (49), bruising / crushing (27), hematomia (34), disruption with divergence of segments (21), accompanied by edema (141); extramedullary lesions: epi- and subdural, intralesive and sub-connective and soft tissues hematomas (68), ruptures of bundles (48), fractures (108), dislocation and subluxation of the vertebrae (35), traumatic disc herniation (37), spinal cord compression and/or rootlets (63), statics violation (134), instability (156).Conclusion.MRI is the optimal method for spinal cord injury diagnostics. In the acute period of injury this technique has limited application, but it can however serve as a primary diagnostic method in these patients. MRI should be performed no later than the first 72 hours after injury. The most optimal for visualization of cervical spine trauma and spinal cord are T2VI SE and STIR in sagittal projection with suppression of signal from fat. MRI results correlate with neurologic symptoms at the time of performance according to the ASIA scale, and therefore MRI should be performed in all patients with acute cervical spine trauma, whenever possible.

Download Full-text