MDCT and MRI evaluation of cervical spine trauma

Abstract

PurposeCervical spine injuries following major trauma result in significant associated morbidity and mortality. Devastating neurological injury, including complete and incomplete tetraplegia, are common sequelae of cervical spine trauma and cause profound and life-altering medical, financial, and social consequences. Most cervical spine injuries follow motor vehicle accidents, falls, and violence. The proliferation of multidetector computed tomography allows for fast and accurate screening for potential bony and vascular injuries. Magnetic resonance imaging is useful for evaluation of the supporting ligaments and the spinal cord after the patient has been stabilised.ConclusionCervical spine injuries are approached with much caution by emergency room clinicians. Thus, it is essential that radiologists be able to differentiate between a stable and unstable injury on MDCT, as this information ultimately helps determine the management of such injuries.Teaching Points:MDCT and MRI are complementary and both may be needed to define injuries and determine management.MDCT rapidly evaluates the bones, and MRI is superior for detecting ligament and cord injuries.Injury to one of the three spinal columns may be stable, and injuries to more than one are unstable.Instability may cause abnormal interspinous and interpedicular distances, or cervical malalignment.Fractures of the foramen transversarium are associated with vertebral arterial dissection.

First performance evaluation of software for automatic segmentation, labeling and reformation of anatomical aligned axial images of the thoracolumbar spine at CT

“…Routinely assessing sagittal reconstructions of the spine is crucial for detection of vertebral body compression fractures in nontrauma patients at abdominal multidetector CTs [11]. Multiplanar reconstructions of the vertebral column improve diagnostic evaluation of the spine [4,24,25]. Sagittal and axial reconstructions are superior to evaluate spinal canal anatomy and stenosis which has been shown to correlate significantly with neurological deficits [26].…”

“…CT is a well established routine imaging modality for evaluation of the thoracolumbar spine [4]. CT is also increasingly used as an initial diagnostic tool in emergency departments [5][6][7][8].…”

“…CT is also increasingly used as an initial diagnostic tool in emergency departments [5][6][7][8]. It allows a rapid evaluation of bony structures and to differentiate between stable and unstable fractures [4]. Evaluation of the thoracolumbar spine on strictly anatomically aligned axially orientated images can be challenging and pathologies may be missed [9].…”

“…11.043 0720-048X/© 2014 Elsevier Ireland Ltd. All rights reserved. injuries in spine trauma MRI is superior to CT, so both techniques are used complementary to define the exact pattern of injuries [4].…”

Multidetector computed tomography and magnetic resonance imaging evaluation of craniovertebral junction abnormalities

“…In our series, the cross-sectional imaging used was MDCT and MRI, as MDCT is ideal modality for evaluation of complex osseous anatomy associated with CVJ abnormalities while MRI, with its multi-planar capabilities and high soft tissue contrast resolution, has become the mainstay in radiological evaluation of the CVJ. [ 13 ] The craniometry of the CVJ uses a series of lines, planes, and angles to define the normal anatomic relationships of the CVJ namely Chamberlain's line, McGregor line, McRae line, Wackenheim clivus line, height index of Klaus, Welcher basal angle, clivus canal angle, atlantooccipital joint axis angle (Schmidt angle), Fishgold digastric line, and Fishgold bimastoid line. [ 1 ] Also CT with its sagittal and coronal reconstruction confirms the diagnosis and helps precisely to know the occipitalization of atlas, hypoplastic posterior arch of atlas, and C1-C2 instability.…”