Several recent papers conclude that CT may be adequate for excluding clinically significant cervical spine injury in patients without neurologic symptoms, even in the setting of neck tenderness [49]. However, recent multicenter trials suggest that CT alone is not sufficient and MRI may be warranted in some patients (see MRI section below). 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 (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]. 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 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; 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. MRI Cervical Spine MRI is generally considered inferior to CT in identifying fractures. MRI is superior to CT in identifying soft- tissue injuries of the cervical spine [37-42]. MRI will identify soft-tissue injuries in 5% to 24% of blunt trauma patients with negative cervical spine CT [39-41,44,45,47,48,55]. The identification of these soft-tissue injuries often results in extended placement of a cervical collar.
Suspected Spine Trauma PCAs. Several recent papers conclude that CT may be adequate for excluding clinically significant cervical spine injury in patients without neurologic symptoms, even in the setting of neck tenderness [49]. However, recent multicenter trials suggest that CT alone is not sufficient and MRI may be warranted in some patients (see MRI section below). 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 (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]. 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 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; 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. MRI Cervical Spine MRI is generally considered inferior to CT in identifying fractures. MRI is superior to CT in identifying soft- tissue injuries of the cervical spine [37-42]. MRI will identify soft-tissue injuries in 5% to 24% of blunt trauma patients with negative cervical spine CT [39-41,44,45,47,48,55]. The identification of these soft-tissue injuries often results in extended placement of a cervical collar.