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Accuracy of Cervical Spine CT for Detection of Craniocervical Junction Ligamentous Injury in Children
Stephen F Kralik1, Yasmin Akbari2, Thierry A G M Huisman2
1From the Texas Children's Hospital, Baylor College of Medicine, Division of Neuroradiology, Edward B. Singleton Department of Radiology, Houston, Texas and Swedish Radia Hospital, Seattle, WA. sfkralik@texaschildrens.org.
Insights
Combining CT findings significantly improves diagnostic accuracy for pediatric craniocervical junction ligamentous injuries. This approach offers high sensitivity and specificity for detecting these critical injuries in children.
Area of Science:
- Radiology
- Pediatric Imaging
- Orthopedic Surgery
Background:
- Craniocervical junction (CCJ) ligamentous injuries in children are challenging to diagnose.
- Cervical spine CT is widely used in trauma, but its accuracy for CCJ ligamentous injury requires evaluation.
Purpose of the Study:
- To assess the diagnostic accuracy of cervical spine CT in detecting ligamentous injuries of the craniocervical junction in pediatric patients.
- To compare CT findings with MRI as the gold standard for CCJ ligamentous injury diagnosis.
Main Methods:
- Retrospective review of pediatric trauma patients (<21 years) with cervical spine CT and MRI.
- Analysis of CCJ measurements on CT (e.g., BDI, ADI, PAAD) and presence of fractures/hemorrhage.
- Calculation of diagnostic accuracy using MRI-confirmed ligamentous injury as the gold standard.
Main Results:
- 193 pediatric patients included; 28% had CCJ ligamentous injury on MRI.
- Individual CT measurements, fractures, and hemorrhage showed low sensitivity but high specificity.
- Combining one or more abnormal CT findings yielded high diagnostic accuracy (AUC=0.86-0.91), with 84-96% sensitivity and 78-95% specificity.
Conclusions:
- The combination of CT measurements, fracture, and hemorrhage significantly enhances diagnostic accuracy for traumatic CCJ ligamentous injuries in children.
- This multimodal CT approach provides excellent diagnostic performance for detecting these injuries.
Purpose:
The purpose of this study is to evaluate the diagnostic accuracy of cervical spine CT for detection of ligamentous injury of the craniocervical junction (CCJ) in children.
Methods:
A retrospective review of pediatric (age < 21 years) trauma patients who underwent cervical spine CT and cervical spine MRI at time of injury was performed. CCJ measurements from the cervical spine CTs included the basion-dens interval (BDI)/basion-cartilaginous dens interval (BCDI), anterior atlantodental interval (ADI), condyle-C1 interval (CCI), C1-C2 lateral mass interval (LMI), lateral atlantodental interval (LADI), posterior atlantoaxial distance (PAAD), and prevertebral soft tissue thickness (PVSTT) at C2. Thresholds for normal and abnormal CT measurements were based on published normative pediatric cervical spine CT measurements. Presence versus absence of CCJ hemorrhage, and fracture(s) of the bones of the CCJ were also recorded. Diagnostic accuracy of CT measurements, fractures and hemorrhage for detection of ligamentous injury was calculated using cervical spine MRI diagnosis of ligamentous injury as the gold standard.
Results:
A total of 193 pediatric patients with average age 13.2 years were included. Motor vehicle accidents and falls were the most common cause of injury. A total of 55 patients (28%) had CCJ ligamentous injury on MRI. The posterior atlantoaxial ligament was the most commonly injured ligament. The incidences of CCJ fractures and hemorrhage were 10.9%, and 9.3%. Individual CCJ measurements, fractures and hemorrhage demonstrated low sensitivity and high specificity for ligamentous injury, however, the combination of one or more abnormal CT finding resulted in a high diagnostic accuracy (AUC=0.86-0.91) with sensitivity or 84-96% and specificity of 78-95% depending on the combination of CT findings used.
Conclusion:
The combination of one or more CCJ measurements, fracture, and hemorrhage results in a very good to excellent level of diagnostic accuracy for detection of traumatic ligamentous injury at the CCJ in pediatric patients.