There are no pediatric studies comparing IV contrast versus noncontrast MRI for the detection of spinal cord injury, but adult studies have shown that contrast-enhanced MRI may be more effective in the evaluation of severe soft-tissue injury but is not more effective for the detection of spinal cord injury [77]. CTA Neck There are currently no sufficient reports regarding outcomes of vascular imaging in children with spinal trauma. Cervical vascular injury in pediatric blunt trauma can be seen in 11.5% of pediatric patients [68]. CT angiography (CTA) has been validated against digital subtraction angiography (DSA) for imaging of cerebrovascular injury in adults, but DSA remains the reference standard [68]. When compared to DSA, CTA has the benefit of being less time intensive, having a lower risk of iatrogenic injury, and having fewer complications than those associated with DSA (such as stroke or death, arterial dissection, and vasospasm) [68,78]. CTA can also be easily performed in conjunction with other CT examinations, and the noninvasive nature of CTA makes it better suited as a screening tool in cervical trauma patients [68,78-80]. Both CTA and MR angiography (MRA) may be considered in children with cervical trauma [68]. Certain risk factors can indicate the need for vascular screening, such as fractures involving the transverse foramen, traumatic facet dislocations (with or without fracture), ligamentous injury, neurological deficits, and fractures of C1-C3 [68,80-82]. Injury patterns at C2 that are specifically associated with vertebral artery injury in adults are dens fractures and traumatic spondylolisthesis [83]. Cerebrovascular injury after blunt trauma was diagnosed with CTA in 5.8% of 137 children with blunt trauma [84]. Scoring systems to identify adult patients that should undergo vascular imaging exist, but they have not been validated in children [85]. MRA Neck In adults, the role of MRA relative to DSA is less well established [68].
Suspected Spine Trauma Child PCAs. There are no pediatric studies comparing IV contrast versus noncontrast MRI for the detection of spinal cord injury, but adult studies have shown that contrast-enhanced MRI may be more effective in the evaluation of severe soft-tissue injury but is not more effective for the detection of spinal cord injury [77]. CTA Neck There are currently no sufficient reports regarding outcomes of vascular imaging in children with spinal trauma. Cervical vascular injury in pediatric blunt trauma can be seen in 11.5% of pediatric patients [68]. CT angiography (CTA) has been validated against digital subtraction angiography (DSA) for imaging of cerebrovascular injury in adults, but DSA remains the reference standard [68]. When compared to DSA, CTA has the benefit of being less time intensive, having a lower risk of iatrogenic injury, and having fewer complications than those associated with DSA (such as stroke or death, arterial dissection, and vasospasm) [68,78]. CTA can also be easily performed in conjunction with other CT examinations, and the noninvasive nature of CTA makes it better suited as a screening tool in cervical trauma patients [68,78-80]. Both CTA and MR angiography (MRA) may be considered in children with cervical trauma [68]. Certain risk factors can indicate the need for vascular screening, such as fractures involving the transverse foramen, traumatic facet dislocations (with or without fracture), ligamentous injury, neurological deficits, and fractures of C1-C3 [68,80-82]. Injury patterns at C2 that are specifically associated with vertebral artery injury in adults are dens fractures and traumatic spondylolisthesis [83]. Cerebrovascular injury after blunt trauma was diagnosed with CTA in 5.8% of 137 children with blunt trauma [84]. Scoring systems to identify adult patients that should undergo vascular imaging exist, but they have not been validated in children [85]. MRA Neck In adults, the role of MRA relative to DSA is less well established [68].