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 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]. 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 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 that include thrombosis that could lead to stroke or death, arterial dissection, and vasospasm [68,78].
Suspected Spine Trauma Child PCAs. 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 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]. 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 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 that include thrombosis that could lead to stroke or death, arterial dissection, and vasospasm [68,78].