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]. CT may be adequate for excluding clinically significant cervical spine injury in patients without neurologic symptoms even in the setting of neck tenderness [49]. CT with IV contrast does not aid in detection of cervical spine injury. CTA Head and Neck CT is the gold standard for identifying cervical spine fractures. CT during arterial phase of IV contrast administration (ie, CT angiography [CTA]) provides the added benefit of excellent visualization of arterial vasculature for assessment of arterial injury. CTA is inferior to catheter angiography in identification of cervical arterial injury [50,51]. Using catheter angiography as a gold standard, recent studies using multislice CT scanners with 16 or more detector rows have found CTA to have a reported sensitivity of 41% to 98% and specificity of 81% to 100% for identifying cervical arterial injury [43,44]. However, CTA has been shown to identify all clinically significant cervical arterial injuries [52,53], and using catheter angiography as the gold standard inherently places CTA at a disadvantage when comparing the two modalities, since catheter angiography arterial injury [50,54] is assumed to be 100% sensitive and 100% specific. CTA does expose patients to potential adverse events associated with IV contrast and can make diagnosis of subtle cervical spine fractures more challenging because of the superimposition of high attenuating contrast on the imaging field if an unenhanced examination was not performed before giving contrast. Dual-energy CT may also be utilized to remove contrast enhancement; Suspected Spine Trauma however, dual-energy CT is not widely available. CTA imaging is best reserved for patients with a high index of suspicion for cervical arterial injury.
Suspected Spine Trauma PCAs. 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]. CT may be adequate for excluding clinically significant cervical spine injury in patients without neurologic symptoms even in the setting of neck tenderness [49]. CT with IV contrast does not aid in detection of cervical spine injury. CTA Head and Neck CT is the gold standard for identifying cervical spine fractures. CT during arterial phase of IV contrast administration (ie, CT angiography [CTA]) provides the added benefit of excellent visualization of arterial vasculature for assessment of arterial injury. CTA is inferior to catheter angiography in identification of cervical arterial injury [50,51]. Using catheter angiography as a gold standard, recent studies using multislice CT scanners with 16 or more detector rows have found CTA to have a reported sensitivity of 41% to 98% and specificity of 81% to 100% for identifying cervical arterial injury [43,44]. However, CTA has been shown to identify all clinically significant cervical arterial injuries [52,53], and using catheter angiography as the gold standard inherently places CTA at a disadvantage when comparing the two modalities, since catheter angiography arterial injury [50,54] is assumed to be 100% sensitive and 100% specific. CTA does expose patients to potential adverse events associated with IV contrast and can make diagnosis of subtle cervical spine fractures more challenging because of the superimposition of high attenuating contrast on the imaging field if an unenhanced examination was not performed before giving contrast. Dual-energy CT may also be utilized to remove contrast enhancement; Suspected Spine Trauma however, dual-energy CT is not widely available. CTA imaging is best reserved for patients with a high index of suspicion for cervical arterial injury.