Pediatric cervical spine clearance after blunt trauma and negative CT: What is the role of MRI?

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology Pub Date : 2024-05-25 DOI:10.1016/j.neurad.2024.101206

Nazanin Azizi, Jimmy L. Huynh, Osama Raslan, Matthew Bobinski, Lotfi Hacein-Bey, Arzu Ozturk

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引用次数: 0

Abstract

Background and purpose

The cervical spine in children has marked anatomical and biomechanical differences compared to adults, leading to significantly different patterns and incidence of spinal injury, and consequently to different X-ray and computed tomography (CT) imaging recommendations. Magnetic resonance imaging (MRI) has been validated to clear cervical spine trauma in adults, but not in pediatric patients. We hypothesized that MRI findings have a low probability to change management in children with spine trauma and negative CT findings.

Materials and methods

We reviewed records for admitted pediatric patients due to blunt trauma from January 2011 to May 2021, and identified 212 patients who underwent MRI within 3 days of a negative CT. Two neuroradiologists independently reviewed all CT and MRI images for the following categories: fracture, subluxation, spinal canal compromise, ligamentous injury, spinal canal hemorrhage, cord contusion and soft tissue hemorrhage. We identified follow-up MRI examinations as negative or positive for the above categories, and calculated the prevalence of each category as a percentage of cases with negative CT. We also evaluated whether negative and positive MRI groups differed significantly with respect to age and sex of the patients.

Results and conclusions

In our study of 212 children with cervical spine trauma and a negative CT, most follow-up MRI scans were found to be negative (79.9 %). Positive MRI findings consisted mainly of ligamentous sprain without disruption (15.1 %). Ligamentous disruption and epidural or soft tissue hemorrhage were found in 4.5 %, and focal cord contusion in 0.5 %. There was no statically significant difference between negative and positive MRI groups with respect to age (P = 0.45) and sex (P = 0.52).

Conclusion

In our patient group with a negative CT, MRI did not significantly impact management nor contribute to cervical spine clearance in children.

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钝性外伤和 CT 阴性后的小儿颈椎清创：核磁共振成像的作用是什么？

背景和目的：与成人相比，儿童的颈椎在解剖学和生物力学上有明显的差异，导致脊柱损伤的模式和发生率明显不同，因此也有不同的 X 光和计算机断层扫描（CT）成像建议。磁共振成像（MRI）已被证实可用于明确成人颈椎创伤，但在儿科患者中尚未得到证实。我们假设，对于脊柱外伤且 CT 检查结果呈阴性的儿童患者，磁共振成像结果改变治疗方案的可能性较低：我们查阅了 2011 年 1 月至 2021 年 5 月期间因钝性外伤入院的儿科患者的病历，并确定了 212 名在 CT 阴性后 3 天内接受 MRI 检查的患者。两名神经放射科医生独立审查了所有 CT 和 MRI 图像，以确定以下类别：骨折、脱位、椎管损伤、韧带损伤、椎管出血、脊髓挫伤和软组织出血。我们将后续磁共振成像检查确定为上述类别的阴性或阳性，并以 CT 阴性病例的百分比来计算每个类别的患病率。我们还评估了磁共振成像阴性组和阳性组在患者年龄和性别方面是否存在显著差异：在我们对 212 名颈椎外伤且 CT 阴性的儿童进行的研究中，发现大多数随访核磁共振扫描结果为阴性（79.9%）。核磁共振成像阳性结果主要是韧带扭伤而无中断（15.1%）。韧带断裂和硬膜外或软组织出血占 4.5%，局灶性脊髓挫伤占 0.5%。核磁共振成像阴性组和阳性组在年龄（P = 0.45）和性别（P = 0.52）方面的差异无统计学意义：结论：在我们的 CT 阴性患者群体中，磁共振成像对儿童颈椎病的治疗没有明显影响，也无助于颈椎病的清除。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroradiology 医学-核医学

CiteScore

6.10

自引率

5.70%

发文量

142

审稿时长

6-12 weeks

期刊介绍： The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.