A retrospective comparison of CT and MRI in detecting pediatric cervical spine injury

Abstract

Using CT as the standard for osseous injury, MRI had a sensitivity of 100%, specificity of 97%, negative predictive value (NPV) of 75%, and positive predictive value (PPV) of 100%. Using MRI as the standard for soft tissue injury, CT had a sensitivity of 23%, specificity of 100%, NPV of 88%, and PPV of 100%. Further studies are required to investigate the use of MRI to detect osseous injuries.

Pediatric Cervical Spine Injuries

“…In 603 low-risk patients (absence of any of the NEXUS criteria) no spinal injury was detected. 3,[7][8][9][10][30][31][32] The lateral view provides the highest sensitivity of up to 93% depending on patient age. 11 A major limitation of this study is that only 2.8% of the included patients were under the age of 2, which is the most crucial age group.…”

“…3,[9][10][11]26,27 Garton and Hammer 28 found a remarkably lower sensitivity for the NEXUS criteria of 85% among children under the age of 9 years, and because of this, the Congress of Neurological Surgeons guidelines recommend application of the NEXUS decision instrument only in children over the age of 9 years. 7,9,26,30,35 An immediate MRI scan is not always available at initial presentation, and the test often requires the patient to lay still for up to 30 minutes. 29 Evaluation of pediatric cervical spine radiographs requires a high index of suspicion.…”

“…29 Accordingly, if the patient is neurologically intact and has no posterior cervical midline tenderness or neurological deficits, there is no need for radiographic imaging. 3,[7][8][9]30 Nevertheless, a MRI scan is recommended in cases of posttraumatic neurological impairment. 10 Standard radiographic diagnostic studies consist of a 3-plane radiograph set.…”

“…29 Evaluation of pediatric cervical spine radiographs requires a high index of suspicion. 2,[4][5][6][7]9,29,30,32,36,37 Computed tomography (CT) is generally available, and can often be performed relatively quickly. The cervical spine is recorded in an anteroposterior, a lateral, and an odontoid view.…”

“…10 Standard radiographic diagnostic studies consist of a 3-plane radiograph set. 2,6,7,9,29,30,34,38 However, because of limited advantages, and higher radiation compared with plain radiographs, the true value of CT in PCSI remains controversial. 3,[7][8][9][10][30][31][32] The lateral view provides the highest sensitivity of up to 93% depending on patient age.…”