Arteriography Cervicocerebral There is no role for arteriography in the initial assessment of patients with low risk for cervical spine injury. Variant 2: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Imaging indicated by NEXUS or CCR clinical criteria. Initial imaging. The high sensitivity of both the NEXUS criteria and CCR for detecting significant cervical spine injury comes at a cost of both criteria having a very low specificity for significant cervical spine injury. NEXUS has a reported sensitivity of 81.2% to 99.6% with a specificity of 12.9% to 45.8% [4,11]. The original study of CCR by Stiell et al [5] reported a sensitivity of 100%, which was confirmed in later studies by Duane et al [11,12]. In head-to-head comparisons, specificity of CCR has been reported from 0.6% to 42.5% [5,7,11,12], overlapping that of the NEXUS criteria. Both of these criteria are widely used for clinical screening for cervical spine injury, and it is generally accepted that patients who do not meet either the NEXUS or CCR criteria do not require imaging evaluation for cervical spine injury. CT Myelography Cervical Spine There is no role for CT myelography in the initial assessment of patients with suspected cervical spine injury. Suspected Spine Trauma CT Cervical Spine CT is excellent at identifying cervical spine injuries. CT is considered the gold standard for identification of cervical spine fractures, outperforming radiographs in identification of cervical spine fractures in high-, moderate- and low-risk stratifications [31]. CT is inferior to MRI in identification of many soft-tissue injuries, such as epidural hematoma, cord contusion, and ligament sprains [37-42]. However, MRI occasionally identifies cervical spine instability that was not appreciable on CT. Less than 1% of unexaminable patients will have evidence of cervical spine instability on MRI that is not appreciated on CT [40,41,43-48].
Suspected Spine Trauma PCAs. Arteriography Cervicocerebral There is no role for arteriography in the initial assessment of patients with low risk for cervical spine injury. Variant 2: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Imaging indicated by NEXUS or CCR clinical criteria. Initial imaging. The high sensitivity of both the NEXUS criteria and CCR for detecting significant cervical spine injury comes at a cost of both criteria having a very low specificity for significant cervical spine injury. NEXUS has a reported sensitivity of 81.2% to 99.6% with a specificity of 12.9% to 45.8% [4,11]. The original study of CCR by Stiell et al [5] reported a sensitivity of 100%, which was confirmed in later studies by Duane et al [11,12]. In head-to-head comparisons, specificity of CCR has been reported from 0.6% to 42.5% [5,7,11,12], overlapping that of the NEXUS criteria. Both of these criteria are widely used for clinical screening for cervical spine injury, and it is generally accepted that patients who do not meet either the NEXUS or CCR criteria do not require imaging evaluation for cervical spine injury. CT Myelography Cervical Spine There is no role for CT myelography in the initial assessment of patients with suspected cervical spine injury. Suspected Spine Trauma CT Cervical Spine CT is excellent at identifying cervical spine injuries. CT is considered the gold standard for identification of cervical spine fractures, outperforming radiographs in identification of cervical spine fractures in high-, moderate- and low-risk stratifications [31]. CT is inferior to MRI in identification of many soft-tissue injuries, such as epidural hematoma, cord contusion, and ligament sprains [37-42]. However, MRI occasionally identifies cervical spine instability that was not appreciable on CT. Less than 1% of unexaminable patients will have evidence of cervical spine instability on MRI that is not appreciated on CT [40,41,43-48].