MULTISPIRAL COMPUTED AND MAGNETIC RESONANCE IMAGING OF THORACOLUMBAR SPINE INJURY IN CHILDREN

Abstract

Introduction. Spinal injury in pediatric practice is met relatively rare; spinal fractures in children do not exceed 5%, and the incidence rate does not exceed 5:100000. However, spinal injuries have a high rate of fetal outcomes (up to 5-10%), and have significant long-lasting negative effects. Therefore, to timely detect such injuries is extremely important for determining treatment tactics, preventing secondary damage to nerve structures and preventing the formation of spinal deformity. Purpose. To assess and compare CT and MRI potentials for developing a diagnostic algorithm in children with thoracolumbar spine injury. Material and methods. 4355 patients, aged 6 months - 17 years, with thoracolumbal spine injury were included into the study . All patients had radiography of the thoracic or lumbar spine and MRI of three spinal sections. Multispiral computed tomography ( MSCT) was performed with Brilliance 16 and 64 scanners. Information on the thoracolumbal spine picture obtained by scanning the chest and abdomen was assessed using findings of frontal and sagittal and 3D reformatted images. MRI was performed on Achieva 3 T scanner; multi-planar T1-, T2-weighted images of (WI) TSE and STIR images in axial, frontal and sagittal projections with a slice thickness of 2-4 mm were obtained. A special spinal 32 channel coil was used. Results. To compare the effectiveness of CT and MRI techniques in the diagnostics of thoracolumbar spinal injury, a sampling of 95 patients was selected. The number of injuries (total and their distribution by the type of injury) was defined using the sample findings. The total number of detected injuries was: only by MRI = 325; only by CT = 228; MRI + CT = 199. By the results of McNemar test, it has been found out that MRI detects statistically significantly better explosive fractures of the vertebrae, ruptures of the posterior longitudinal ligament (PLL) and yellow ligament (YL), ruptures of third column ligaments, herniated discs, epidural and sublingual hematomas, hematomyelia, complete and partial ruptures of the spinal cord and its edema; CT has superiority in detecting fractures of posterior vertebral elements. Conclusion. Currently, MSCT remains a key imaging technique in the diagnostics of acute spinal injuries in most cases in children and adults. Our findings confirm that MRI - in the absence of standard absolute contraindications - can serve as a worthy alternative for assessing damages of the vertebral bodies, ligaments, intervertebral discs, spinal cord and its roots in the acute stage of injury, yielding only in detecting injuries in vertebra posterior elements. The absence of ionizing radiation is also one of MSCT advantages which makes its use preferable for spinal injury diagnostics in children, both for primary and for control examinations.