Studies comparing CTA, MRA, and DSA have found that CTA has comparable accuracy compared to DSA, while MRA tended to overestimate stenosis and occlusion [68]. Lower-grade vascular injuries may be missed with CTA but not with DSA, even though they are usually asymptomatic [80]. A benefit of MRA over CTA and DSA is its ability to identify intramural hematomas and early ischemic injuries [68]. To date, despite the benefits of MRI as a noninvasive examination, the Eastern Association for the Surgery of Trauma states that MRA should not be considered as the sole imaging modality for blunt cerebrovascular injury based on lower sensitivity of MRA relative to DSA in detecting traumatic vascular injuries in adults [86]. Arteriography Cervicocerebral DSA remains the reference standard for cerebrovascular injury in adults [68]. There is no recent scientific literature evaluating the use of DSA in children with spinal trauma. DSA is more time consuming and associated with severe risks, including thrombosis, that could lead to stroke or death, arterial dissection, and vasospasm [68,78]. US Cervical Spine The value of US has only recently been explored in pediatric cervical spine trauma and is not yet established [87]. Integrity of the posterior ligamentous complex plays an integral role for stability of the spine, and presence of posterior ligamentous complex injury may indicate more severe damage and change treatment interventions [88]. MRI is the modality of choice for evaluation of the posterior ligamentous complex, but it was shown that its sensitivity and specificity are lower than previously thought [89]. CT Myelography Cervical Spine CT myelography is rarely performed and has been largely replaced with MRI. Exceptional indications may exist for patients with contraindications to MRI and in whom impending cord compression is suspected [90].
Suspected Spine Trauma Child PCAs. Studies comparing CTA, MRA, and DSA have found that CTA has comparable accuracy compared to DSA, while MRA tended to overestimate stenosis and occlusion [68]. Lower-grade vascular injuries may be missed with CTA but not with DSA, even though they are usually asymptomatic [80]. A benefit of MRA over CTA and DSA is its ability to identify intramural hematomas and early ischemic injuries [68]. To date, despite the benefits of MRI as a noninvasive examination, the Eastern Association for the Surgery of Trauma states that MRA should not be considered as the sole imaging modality for blunt cerebrovascular injury based on lower sensitivity of MRA relative to DSA in detecting traumatic vascular injuries in adults [86]. Arteriography Cervicocerebral DSA remains the reference standard for cerebrovascular injury in adults [68]. There is no recent scientific literature evaluating the use of DSA in children with spinal trauma. DSA is more time consuming and associated with severe risks, including thrombosis, that could lead to stroke or death, arterial dissection, and vasospasm [68,78]. US Cervical Spine The value of US has only recently been explored in pediatric cervical spine trauma and is not yet established [87]. Integrity of the posterior ligamentous complex plays an integral role for stability of the spine, and presence of posterior ligamentous complex injury may indicate more severe damage and change treatment interventions [88]. MRI is the modality of choice for evaluation of the posterior ligamentous complex, but it was shown that its sensitivity and specificity are lower than previously thought [89]. CT Myelography Cervical Spine CT myelography is rarely performed and has been largely replaced with MRI. Exceptional indications may exist for patients with contraindications to MRI and in whom impending cord compression is suspected [90].