Normal Pediatric Prevertebral Soft-Tissue Thickness on MDCT

Vermess, David; Rojas, Carlos; Shaheen, Fawad; Roy, Pinakpani; Martinez, Carlos R.

doi:10.2214/ajr.10.6288

Cited by 19 publications

(12 citation statements)

References 16 publications

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“…Before starting this study, we examined different types of reconstructions and imaging combinations, ultimately determining that combined conventional and electron density images were most accurate. Previous studies suggest that conventional CT has limited value regarding prevertebral hematoma and increased prevertebral soft-tissue thickness is considered as an indirect sign of prevertebral hematoma [5,18,28]. In our study conventional CT did not deliver reliable diagnostic accuracy either, with a sensitivity of 33-50 % and a specificity of 75-80 %.…”

Section: Discussioncontrasting

confidence: 78%

Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine

Sedaghat

Langguth

Larsen

et al. 2021

Rofo

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Purpose To investigate the diagnostic value of dual-layer spectral detector computed tomography (SDCT) in detecting posttraumatic prevertebral hematoma of the cervical spine by including electron density images. Methods 38 patients with post-traumatic imaging of the cervical spine were included in this study and received both SDCT and MRI examinations. MRI was set as the reference and combined conventional/electron density (C + ED) images were compared to conventional CT (CCT) images alone. Results A total of 18 prevertebral hematomas were identified. Reader 1 identified 14 of 18 and reader 2 15 of 18 prevertebral hematomas by using C + ED reconstructions. Readers 1 and 2 detected 6 and 9 of 18 hematomas on CCT, respectively. CCT showed a sensitivity of 33–50 % and a specificity of 75–80 %, while for C + ED reconstructed images the sensitivity was 77–83 % and the specificity was 85–90 %. Accuracy increased from 55–66 % to 84 % by using C + ED images. The minimum thickness for detecting hematoma on C + ED images was 3 mm. The sizes of prevertebral hematoma on CCT/C + ED were not significantly under- or overestimated compared to the MRI reference. There was a significant difference between the two readers for measuring hematoma sizes on CCT (p = 0.04). Readers showed an excellent inter-rater reliability (kappa = 0.82) for C + ED images and a moderative inter-rater reliability (kappa = 0.44) for CCT. Conclusion With SDCT, the diagnostic accuracy for detecting post-traumatic prevertebral hematoma is improved by using combined conventional and electron density reconstructions compared to conventional images alone. Key Points: Citation Format

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Section: Discussioncontrasting

confidence: 78%

Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine

Sedaghat

Langguth

Larsen

et al. 2021

Rofo

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“…Reduced width of the prevertebral soft-tissue thickening (orange lines) could signify a relief of previously swollen soft-tissue. 19 The patient was subsequently reviewed at the 18th month and remained symptoms free. No adverse events had occurred during the 12 months of care ( Figure 2 ).…”

Section: Case Reportmentioning

confidence: 99%

Cervicogenic Dizziness in an 11-Year-Old Girl: A Case Report

Chu

Wong

2021

AHMT

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Cervicogenic dizziness (CGD) is a syndrome of neck pain accompanied by a false sensation of unsteadiness and dizziness due to neck pathology. An 11-year-old girl presented with neck pain and dizziness for four months. According to the patient’s statement, her complaints were likely related to the prolonged smartphone use for texting. Sagittal radiograph showed cervical kyphosis, anterior wedging of several vertebrae, and mild anterolisthesis of C2 on C3 and C3 on C4. These findings might be present in as physiological variants in children. However, continuous static stress in the minor variants could aggravate biomechanical problems, such as cervicogenic dizziness. After ruling out other neurological or vestibular problems, a multicomponent approach consisted of thermal ultrasound therapy, cervical manipulation, and intermittent motorized cervicothoracic traction to release cervical complaints. Three months later, the patient reported a resolution of neck pain and dizziness. At 12-month follow-up, all radiographic metrics showed improvement, including restoration of cervical alignment and lordotic curvature. The immature growing cervical spine has unique anatomic, physiologic and biomechanical features. A static neck flexion can lead to typical injury patterns seen in this age group. This article aims to raise awareness of the potential harms of excessive smartphone use by children.

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“…Treatment strategies for atlas fractures in children are discussed controversially 31. We agree with Kazanci et al 21 that management of stable and unstable fractures of the atlas Gehweiler type I in toddlers depends on whether they occur in combination with or without other C-spine injuries or alone 21 32.…”

Section: Discussionmentioning

confidence: 55%

“…However, no such measurements have been established for children. Keene and colleagues suggested that by CT studies of the upper C-spine, fractures and displacement of the atlas relative to the odontoid process can be readily shown and correctly assessed 31. Most authors apply the rule of Spence in children to discern unstable from stable atlas fractures 30.…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of fractured anterior arch of the atlas in a young child

Sesia¹,

Prüfer

Walther

et al. 2017

BMJ Case Reports

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A 2-year-old girl fell off a bunk bed onto a parquet floor. She immediately reported neck pain and presented with muscle spasm and limited motion of the cervical spine (C-spine). Plain X-rays of the C-spine showed no osseous lesion. Owing to persisting pain and limited motion in the neck, MRI of the C-spine was obtained which revealed intact ligaments and cervical spinal cord, as well as soft tissue swelling in front of the anterior arch of the atlas. Subsequent CT of the C-spine confirmed a complete, undisplaced fracture of the anterior arch of the atlas (Gehweiler type I fracture). A Minerva cast was applied for 2 months, followed by a soft cervical collar. Persistent neck pain and limited range of motion of the neck after a fall may be indicative of atlas fracture that should be ruled out by CT.

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Normal Pediatric Prevertebral Soft-Tissue Thickness on MDCT

Cited by 19 publications

References 16 publications

Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine

Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine

Cervicogenic Dizziness in an 11-Year-Old Girl: A Case Report

Delayed diagnosis of fractured anterior arch of the atlas in a young child

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