MR Imaging Findings in Spinal Ligamentous Injury

Benedetti, Philip F.; Fahr, Linda M.; Kuhns, Lawrence R.; Hayman, L. Anne

doi:10.2214/ajr.175.3.1750661

Cited by 52 publications

(36 citation statements)

References 8 publications

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“…These ligaments and membranes are relatively anhydrous structures and hence normally appear hypointense on all MR pulse sequences. Sagittal T2-weighted (T2W) and STIR images offer a global view of the post trauma spine where ligamentous and membranous tear may be readily diagnosed [5,6,12] (Fig. 2a).…”

Section: Craniovertebral Junction Injuriesmentioning

confidence: 99%

“…13). Fat suppression afforded by inversion recovery technique improves sensitivity for soft tissue and ligament trauma [5,27,28]. Acute trauma patients are usually in a great deal of pain, and the resolution of MRI studies is often limited due to patient motion.…”

Section: Injury To Soft Tissues Posterior To the Spinal Cordmentioning

confidence: 99%

“…MRI is being more commonly used in the assessment of cervical spine trauma in the acute setting, in some cases necessitating immediate interpretation by the oncall resident, further emphasizing the need for familiarity with the various findings of cervical spine trauma on MRI. Previous pictorial reviews have presented normal MRI anatomy of cervical spinal ligaments [4] and findings of spinal ligamentous injury [5][6][7][8][9]. The purpose of this article is to further familiarize the reader with MR findings of cervical spinal trauma, with focus on soft tissue injury.…”

Section: Introductionmentioning

confidence: 99%

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MR imaging of acute cervical spinal ligamentous and soft tissue trauma

Dundamadappa

Cauley

2012

Emerg Radiol

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The increasing availability of magnetic resonance imaging (MRI) and the high sensitivity of MRI for soft tissue injury are resulting in the increased use of MRI for the evaluation of acute trauma. As cervical spine injury can have a devastating consequence, MRI is being more commonly used to evaluate cervical spine injury in the acute setting, necessitating emergent interpretation by the on-call radiologist. Unless one is formally trained in a trauma center, the MRI findings of soft tissue and ligamentous cervical spine injury may not be fully appreciated. The goal of this pictorial review is to familiarize the reader with some of the more common soft tissue, vascular, and ligamentous injuries seen on MRI of the cervical spine in the emergent setting.

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Section: Craniovertebral Junction Injuriesmentioning

confidence: 99%

Section: Injury To Soft Tissues Posterior To the Spinal Cordmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MR imaging of acute cervical spinal ligamentous and soft tissue trauma

Dundamadappa

Cauley

2012

Emerg Radiol

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“…Hence, we were not able to determine the short-and long-term sequelae of craniocervical injury, the temporal evolution of REHs, the recovery of ligamentous injury, the degree of residual craniocervical stability, and the degree of accelerated degenerative disease of the cervical spine. 14 The paucity of articles discussing the occurrence of tectorial membrane injuries in children after high-speed MVAs suggests that these injuries are frequently underestimated or even overlooked. Injury of the tectorial membrane and other craniocervical junction ligaments may have a significant impact on the stability of the craniocervical junction.…”

Section: Mechanism Of Traumamentioning

confidence: 99%

Tectorial Membrane Injury: Frequently Overlooked in Pediatric Traumatic Head Injury

Meoded¹,

Singhi²,

Poretti³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:REHs and tectorial membrane injuries are rare complications of pediatric head and neck injuries. We aim to describe the neuroimaging findings in pediatric REHs, to summarize the mechanism of injury, and to correlate the imaging findings with the clinical presentation. We retrospectively evaluated CT and/or MR imaging studies of 10 children with traumatic REH. Most patients were involved in MVAs. The tectorial membrane was injured in 70% of patients, and REHs were medium to large in 80%. None of the patients had a focal spinal cord or brain stem injury, craniocervical junction dislocation, or vertebral fractures. Tectorial membrane disruption was diagnosed in most patients without craniocervical junctionϪrelated symptoms. Tectorial membrane lesions and REHs were seen in young children who sustained high-speed head and neck injuries. Clinical symptoms may be minimal or misleading. The radiologist should be aware of these injuries in children. MR imaging appears to be more sensitive than CT.ABBREVIATIONS: DAI ϭ diffuse axonal injury; GCS ϭ Glasgow Coma Scale; MVA ϭ motor vehicle accident; REH ϭ retroclival epidural hematoma; STIR ϭ short T1 inversion recovery R EH and tectorial membrane injuries are rare complications of traumatic head-neck injuries. Only 1.2%-12.9% of all posterior fossa epidural hematomas are located in the retroclival epidural space.1-5 REHs have only been reported in a few children and even more rarely in the adult population. 6,7 Most pediatric traumatic REHs are seen in children involved in MVAs.8 Tectorial membrane disruption has been reported to be 1 of the most important factors resulting in the formation of a REH. None of the previous reports, however, have systematically studied the simultaneous occurrence of REH and tectorial membrane injuries in children. 6 Conventional radiography and CT are typically used in acute trauma to exclude injury to the brain or cervical spine. Conventional radiography and CT may, however, not always detect craniocervical junction injuries adequately or may underestimate the degree and extent of injury. MR imaging is the technique of choice for the detailed assessment of craniocervical junction injuries. MR imaging also allows the evaluation of the lower brain stem and cervical spinal cord with higher sensitivity and specificity. 6,9 The goals of our report are the following: 1) to describe the CT and MR imaging features in children with confirmed traumatic REH, 2) to specifically assess the frequency of simultaneous REH and tectorial membrane injury, and 3) to correlate the imaging findings with the clinical presentation. Materials and MethodsTen children with confirmed REH by CT and/or MR imaging were included in the study. All children had experienced an acute significant head and neck injury and were seen at the Johns Hopkins Hospital between June 2006 and July 2010. The age and sex of all patients were recorded. The electronic patient records were reviewed for the following: 1) the mechanism of trauma (eg, fall, MVA), and 2) clinical signs on th...

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“…So the hypothesis that loss of integrity of the membranes in the craniocervical junction might be the cause of neck pain in patients with WADs has been proposed. These structures could be well visualized by magnetic resonance imaging (MRI) [17][18][19]. In recent years, with the development of more detailed MRI techniques morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed [18,[20][21][22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

Shen

2012

Eur Spine J

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Purpose Hypothesis that loss of integrity of the membranes in the craniocervical junction might be the cause of neck pain in patients with whiplash-associated disorders (WADs) has been proposed. In recent years, with development of more detailed magnetic resonance imaging (MRI) techniques, morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed. A metaanalysis was performed to evaluate the relationship of MRI signal changes of alar and transverse ligaments and WADs. Methods A systematic search of EMBASE, PUBMED, and Cochrane Library and references from eligible articles were conducted. Comparative studies reporting on evaluating the relationship between MRI high-signal changes of alar and transverse ligaments and WADs were regarded eligible. A pooled estimate of effect size was produced. Results Alar ligaments: Six studies (total n = 622) were included. MRI signal changes of alar ligaments did not appear to be related with WADs (P = 0.20, OR = 1.54, 95 % CI = 0.80-2.94). Heterogeneity was present (I 2 = 46 %, P = 0.10), which was eliminated upon sensitivity analysis bringing the OR to 1.27 (95 % CI = 0.87-1.86, I 2 = 0 %). Transverse ligaments: Four studies (total n = 489) were included. MRI signal changes of transverse ligament did not appear to be related with WADs (P = 0.51, OR = 1.44, 95 % CI = 0.49-4.21). Heterogeneity was present (I 2 = 77 %, P = 0.005), which was eliminated upon sensitivity analysis bringing the OR to 0.79 (95 % CI = 0.49-1.28, I 2 = 0 %). Conclusion MRI signal changes of alar and transverse ligaments are not supposed to be caused by whiplash injury, and MRI examination of alar and transverse ligaments should not be used as the routine workup of patients with WADs.

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MR Imaging Findings in Spinal Ligamentous Injury

Cited by 52 publications

References 8 publications

MR imaging of acute cervical spinal ligamentous and soft tissue trauma

MR imaging of acute cervical spinal ligamentous and soft tissue trauma

Tectorial Membrane Injury: Frequently Overlooked in Pediatric Traumatic Head Injury

Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

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