High-resolution computed tomography in injuries to the cervical spine

Correct orthopedic therapy for traumas of the cervical rachis requires perfect knowledge of the spatial balance of the fracture focus. The authors believe Computed Tomography (CT) to be the most suitable, and often indispensable, method for this purpose. Twenty-four patients were examined for traumatic pathology of the cervical rachis. In 7 cases with clinically minor traumas, the negative outcome of the traditional exam was considered reliable and sufficient for therapeutic purposes. The extant 17 patients were examined also by means of CT, either to better determine the characteristics of skeletal lesions already ascertained with traditional techniques or to assess the presence of clinically-suspected osteo-articular lesions, even with negative conventional X-rays. For 9 of these patients orthopedic treatment was considered sufficient, whereas 8 patients underwent surgery and were subsequently examined with CT, which allowed correct evaluation of postoperative pictures even in the presence of metal prostheses. In 10 cases CT demonstrated the presence of lesions which had not been diagnosed with traditional X-ray techniques.     

Multidetector computed tomography of cervical spine fractures in ankylosing spondylitis

PURPOSE: To analyze multidetector computed tomography (MDCT) cervical spine findings in trauma patients with advanced ankylosing spondylitis (AS). MATERIAL AND METHODS: Using PACS, 2282 cervical spine MDCT examinations requested by emergency room physicians were found during a period of 3 years. Of these patients, 18 (16 M, aged 41-87, mean 57 years) had advanced AS. Primary imaging included radiography in 12 and MRI in 11 patients. RESULTS: MDCT detected one facet joint subluxation and 31 fractures in 17 patients: 14 transverse fractures, 8 spinous process fractures, 2 Jefferson's fractures, 1 type I and 2 type II odontoid process fractures, and 1 each: atlanto-occipital joint fracture and C2 laminar fracture plus isolated transverse process and facet joint fractures. Radiographs detected 48% and MRI 60% of the fractures. MRI detected all transverse and odontoid fractures, demonstrating spinal cord abnormalities in 72%. CONCLUSION: MDCT is superior to plain radiographs or MRI, showing significantly more injuries and yielding more information on fracture morphology. MRI is valuable, however, in evaluating the spinal cord and soft-tissue injuries. Fractures in advanced AS often show an abnormal orientation and are frequently associated with spinal cord injuries. In these patients, for any suspected cervical spine injuries, MDCT is therefore the imaging modality of choice.     

Metrizamide myelography and postmyelographic computed tomography: comparative adequacy in the cervical spine

Metrizamide myelography and postmyelographic computed tomography (CT) were evaluated for relative efficacy when correlated with operative findings in a series of 30 patients. Fifty-seven levels were operated on in the 30 patients with 27 patients diagnosed as having diffuse cervical stenosis, hyperostotic spondylosis, or herniated nucleus pulposus. Metrizamide myelography and CT metrizamide myelography were equally useful in providing preoperative diagnostic information at 44 of 57 levels. Both radiographic techniques agreed with the degree of canal and neural forman stenosis found operatively at more than 80% of levels. This study indicates that either metrizamide myelography or CT myelography alone is sufficient, and that both should be performed only if one fails to answer the clinical question or if syringomyelia or cord tumors are suspected.     

Three-dimensional computed tomography in acute cervical spine trauma: a preliminary report

Numerically integrated, three dimensional images obtained from axial computed tomography (CT) data are vastly superior to mentally-integrated, individual, multiplanar CT images for the evaluation and diagnosis of acute cervical spine injury. This superiority results primarily from the visual display of spatial relationships. In addition, three-dimensional CT is capable of detecting injuries not found by conventional radiography or by multiplanar computed tomography (MPCT). The purpose of this preliminary report of four specially selected cases is to illustrate the superiority of three-dimensional CT over other imaging modalities (including MPCT) for the demonstration of cervical spine injuries.     

The value of computed tomography scanning in elusive fractures of the cervical spine

In three cases of injury to the cervical spine, in which plain films and tomographic studies provided inconclusive diagnoses, computed tomography scanning demonstrated the lesions unequivocally. When such diagnostic problems arise the use of this supportive technique is advocated.     

Multidetector computed tomography imaging of the spine

This article discusses applications of multidetector computed tomography imaging of the spine as they were presented at the "Advances in Multidetector CT" meeting held in Washington, DC, September 13-14, 2003. These include imaging the spine in the setting of trauma, postoperative fusion, chronic pain, radiculopathy, or bony lesions and performing image-guided biopsies.     

Orbital apex fractures: the contribution of computed tomography

Computed tomographic scans in 23 patients who had undergone total laryngectomy were analyzed retrospectively to determine normal postoperative appearance and to evaluate the role of CT in assessing recurrent neoplasm. Nine patients without clinical evidence of recurrence illustrated the normal postoperative changes: a round or ovoid neopharynx connecting the base of the tongue with the cervical esophagus and intact fat planes surrounding the neopharynx, neurovascular bundles, and sternocleidomastoid muscles. In the 12 patients with recurrent neoplasm, the CT manifestations included masses involving the internal jugular lymph node chain (adjacent to the neopharynx, neurovascular bundles, or sternocleidomastoid muscles), tracheostomy site, or paratracheal region. Recurrence was mimicked on CT in two patients, one with an abscess and one with metastases from an adenocarcinoma of unknown primary site. In eight patients, a distended neopharyngeal lumen correlated with benign or malignant stricture. CT supplemented physical examination and indirect mirror examination, providing data regarding presence and extent of recurrent tumor and aiding in planning the mode and scope of therapy.     

Regional variations in the thickness of cervical spine endplates as measured by computed tomography

Purpose: To determine regional variations in the thickness of human cervical spine endplates with high spatial resolution.

Material and Methods: Six explanted human cadaveric spine specimens underwent computed tomography (CT) scanning. Measurement of endplate thickness was done fully automatically at every point of the endplate using a computer program written specifically for this purpose. Variations in thickness along sagittal and coronal lines were determined and statistical parametric mapping was used to test for significant regional variations at every point.

Results: Anterior and medial aspects of superior endplates were shown to be significantly thinner than lateral and dorsal parts. Superior endplates were found to be thicker than inferior endplates.

Conclusion: Fully automatic assessment of endplate thickness from CT data is feasible. Central regions of the cervical spine endplates are thinner than peripheral parts of the endplates. This distribution is more pronounced in superior than in inferior endplates.     

Clearing the cervical spine in multiple trauma victims: A time-effective protocol using helical computed tomography

This study was performed to evaluate helical computed tomography (HCT) as the primary method of initial cervical spine assessment in multiple trauma victims. Prospective evaluation of the cervical spine using HCT and plain film radiography (PFR) was performed in 800 patients with suspected multisystem injuries. With HCT, an average of 32 slices were obtained at 5-mm intervals from the base of the skull to T1 using helical acquisition and a bone algorithm. HCT was performed following cross-table lateral radiographs of the cervical spine in all patients. We compared HCT and PFR for detection of abnormalities and duration of examination and also compared HCT with conventional CT in a subset of patients (N=20) for image quality/lesion detectability. Sixty-eight fractures were identified in 46 patients. HCT prospectively identified 67 fractures (98.5%), and plain films demonstrated 29 fractures (43%). No difference in image quality/lesion detectability was encountered when comparing HCT to conventional CT. HCT of the cervical spine could be completed in 4.5 minutes and added an average of only 8 minutes to the stay of the patient in the CT room. During the time of the study, the overall patient disposition time from the trauma resuscitation area was reduced from 6.5 to 4.5 hours. Rapid and accurate evaluation of the cervical spine is possible with HCT and is recommended as part of the initial imaging protocol in multiple trauma patients.     

Localization of scanning level in computed tomography of the spine.

A simple method for identifying the scanning level in computed tomography (CT) of the spine is described. The method involves exposing a lead lattice grid on a conventional X-ray film and taking a conventional spine film with aluminum markers on the patient's back. The film showing the grid and the markers on the patient's spine is used to localize the CT scans taken with the aluminum markers still on the patient's back.     

The normal cervical spine and its variations on plain radiography and computed tomography

To detect abnormalities of the injured bony cervical spine, it is necessary to have a thorough knowledge of the normal cervical spine’s anatomy and its variations. It is the purpose of this article to emphasize the visual characteristics of the normal appearances in order to assist in the determination of whether the examination is normal or abnormal. Because of these visual characteristics, it is at times possible to be certain that the examination is normal solely on basis of the plain radiographs. On other occasions, because the plain radiographic appearance of normal and abnormal may overlap, further evaluation with computed tomography is necessary. Rarely, even with computed tomography, the appearance of normal, subacute injury, and acute injury may not be distinguishable.     

Computer-assisted tomography in the assessment of cervical spine trauma.

Four patients with cervical spine trauma were examined by computerised tomography in addition to standard radiography and additional useful information was thereby gained. The axial projection is particularly useful in studying the cervical spinal canal and neural arch. The examination may be performed rapidly without moving the patient, an important consideration after severe trauma.     

The contribution of computed tomography to the evaluation of the obstructed ureter

Computed tomography (CT) has been found to make a valuable contribution to the diagnosis of the etiology of ureteral obstruction when routine urography and pyelography have not been diagnostic. We believe CT can replace more invasive techniques such as antegrade pyelography and even retrograde pyelography in the evaluation of many of these cases. This presentation will summarize our experience with the use of CT to evaluate the etiology of ureteral obstruction, indicate those disease processes likely to be encountered, emphasize the limitations of the technique, and indicate the place CT has in the study of these patients.     

Correlating first- and second-rib fractures noted on spine computed tomography with major vessel injury

First- and second-rib fractures diagnosed on plain radiographs have been associated with traumatic aortic injury. We examined whether such fractures diagnosed on computed tomography (CT), which is of greater sensitivity than plain radiograms for rib fractures, are associated with traumatic vascular injury. We identified 1,894 patients who had undergone a chest CT angiogram with indication of trauma between 2005 and 2008. Among these, 185 patients were selected at random. The main mechanism of injury was motor vehicle accident or a fall. The patients were divided into two groups: patients with first- and/or second-rib fractures and those without. Proportions of patients with major vessel injury noted on CT angiography were compared between groups. Information regarding displacement of the fracture, location of the fracture, detection upon plain film, and gender of the patients was also evaluated and correlated with incidence of major vessel injury. Fisher’s test and χ² analysis were used to determine significance of the data. Incidence of major vessel injury was similar between patients with and without first- and/or second-rib fractures (7% vs. 9%, respectively; p = 0.59). No subset of type of rib fracture was associated with greater incidence of aortic injury. First- and second-fractures are not associated with greater incidence of aortic injury. Thus, the previous axiom that first- and second-rib fractures should result in increased examination for aortic injury may not hold true.     

Computed tomography of acute cervical spine tendinitis

The authors present the first case of acute calcific tendinitis of the neck seen on computed tomography. Although clinical presentation and routine radiographs suggested the diagnosis, computed tomography established it by illustrating calcification of the longus colli muscle that was not seen on the radiographs. The illustrations and interesting aspects of the case are described.     

The diagnosis of hypertensive intracerebral hemorrhage: the contribution of computed tomography

Sixty-eight cases of hypertensive intracerebral hemorrhage were reviewed and the CT scans studied. The CT scan was accurate in localizing and measuring intracerebral hemorrhage. There were three cases of pontine hemorrhage which did not appear on the CT scan. Hemorrhages at other sites were always seen on the CT scan. The size of putaminal and thalamic hemorrhage as calculated from CT scan allowed accurate prognosis to be made at the onset. CT scanning has become the diagnostic test or first choice when intracerebral hemorrhage is suspected.