Difference between revisions of "CT of the neck in trauma"

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==Planning==
 
==Planning==
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{{Neck trauma - indication for imaging}}
 
{{Neck trauma - choice of modality}}
 
{{Neck trauma - choice of modality}}
 
===Settings===
 
===Settings===

Revision as of 15:16, 7 May 2019

Author: Mikael Häggström [notes 1]

Planning

Indication for imaging

In neck trauma, a normal clinical evaluation may clear the neck without diagnostic imaging, such as using the the Canadian C-spine rule.[1] In practice, there is rarely any reason for a radiologist to decline an imaging request from a clinician for a trauma patient.

Choice of modality

Recommendations differ somewhat between children and adults:

  • In children, CT of the neck in trauma is indicated in more severe cases such as neurologic deficits, whereas X-ray of the cervical spine is preferable in milder cases, by both US[2] and UK[3] guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.[4] It is thus reasonable to indicate CT by a combination of higher severity and older age.
  • In adults, UK guidelines are largely similar as in children.[3] US guidelines, on the other hand, recommend CT of the neck in trauma in all cases where medical imaging is indicated, and that X-ray of the cervical spine is only acceptable where CT is not readily available.[5]

Settings

Thin slices, ideally 1.5 mm or less.[6]

Evaluation

  • Any fracture lines?
  • Incongruences? Lines drawn along the anterior and posterior surfaces of vertebrae as well as the spinous processes should be smooth. Also, the distances between vertebrae and spinous processes should be compared.
  • Prevertebral thickening?

Prevertebral thickening

Upper limits of values vary with body constitution of the patient, but in adults they are generally:[7]

  • C1: 8.5 mm
  • C2: 6 mm
  • C3: 7 mm
  • C4/C5: variable due to variable height for cricoid/oesophagus
  • C6: 18 mm
  • C7: 18 mm

The following are upper limits for prevertebral spaces in children:[8]

Age C2 C6
0-2 years 7.6 mm 9.0 mm
3-6 years 8.4 mm 9.8 mm
7-10 years 6.8 mm 12.1 mm
11-15 years 6.8 mm 14.5 mm

Report

Even absence of:

  • Fracture
  • Misalignment
  • Prevertebral thickening

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. Saragiotto, Bruno T; Maher, Christopher G; Lin, Chung-Wei Christine; Verhagen, Arianne P; Goergen, Stacy; Michaleff, Zoe A (2018). "Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma ". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD012989. ISSN 14651858. 
  2. Julie C Leonard (2018-02-12). Evaluation and acute management of cervical spine injuries in children and adolescents. UpToDate.
  3. 3.0 3.1 . Head injury: assessment and early management. National Institute for Health and Care Excellence (NICE) (2014). Updated in June 2017
  4. . Traumamanual. Region Skåne. Last updated: 2018-03-29
  5. Amy Kaji, Robert S Hockberger (2018-05-24). Evaluation and acute management of cervical spinal column injuries in adults.
  6. Tins, Bernhard (2010). "Technical aspects of CT imaging of the spine ". Insights into Imaging 1 (5-6): 349–359. doi:10.1007/s13244-010-0047-2. ISSN 1869-4101. 
  7. Rojas, C.A.; Vermess, D.; Bertozzi, J.C.; Whitlow, J.; Guidi, C.; Martinez, C.R. (2009). "Normal Thickness and Appearance of the Prevertebral Soft Tissues on Multidetector CT ". American Journal of Neuroradiology 30 (1): 136–141. doi:10.3174/ajnr.A1307. ISSN 0195-6108. 
  8. Error on call to Template:cite web: Parameters url and title must be specifiedJeremy Jones. . Radiopaedia.