William F. Conway, Abstract Co-Author: Nothing to Disclose

Jonathan Kraas MD, Presenter: Nothing to Disclose

Stephen R. Christian MD, Abstract Co-Author: Nothing to Disclose

Thomas L. Pope MD, Abstract Co-Author: Nothing to Disclose

G. Donald Frey PhD, Abstract Co-Author: Nothing to Disclose

The number of CTs performed for the evaluation of c-spine trauma has precipitously increased. This retrospective study was done to determine if the benefits of MDCT c-spines in the pediatric population outweigh the costs.

During 2005, 62 patients 10 y.o. and younger were evaluated with MDCT for acute c-spine trauma. Direct axial and multi-plane reformats were evaluated at the time of injury and retrospectively for osseous and soft tissue abnormalities. Correlation to the presenting neurologic condition of the patient was made. Initial findings also were compared with subsequent imaging studies and clinical outcome. Radiation exposure to the thyroid was calculated individually by a physicist.

No abnormalities were detected prospectively or retrospectively in 59/62 patients. Fractures were identified prospectively in only two patients, both of whom were treated uneventfully with soft cervical collars. A single patient had ligamentous injury which initially went undetected. While hospitalized for other injuries, this patient suffered bilaterally locked facets which resulted in severe spinal cord damage. In retrospect, very subtle splaying of the facets and spinous processes at C6-C7 can be seen on the initial study. At time of presentation, none of the 62 patients underwent voluntary flexion/extension plain film imaging even though 44 were clinically capable. The single MDCT study performed on each patient at presentation resulted in as much as a 10% increased life-time risk of developing thyroid cancer.

Significant injury was present in less than five percent of our study group. Prospectively, only 2 of the 3 injuries were detected. MDCT exposes the patient to the risks of increased radiation with limited sensitivity for the detection of ligamentous injury. Since the pediatric population is more sensitive to radiation and proportionately suffers more ligamentous injuries, perhaps other imaging modalities should be employed at the initial evaluation of c-spine trauma in these patients.

A multi-modality algorithm for the radiologic evaluation of pediatric c-spine trauma will be proposed to limit radiation exposure and increase detection of ligamentous injuries.

Conway, W, Kraas, J, Christian, S, Pope, T, Frey, G, Should CT Always Be the Imaging Modality of Choice for Pediatric Patients Who Have Suffered Acute C-Spine Trauma?.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4435276.html