Row Computed Tomography Research Articles

小児ＣＴ検査における ａｄａｐｔｉｖｅ ｄｏｓｅ ｓｈｉｅｌｄの有用性について

The spiral scan with a wide detector row such as the 64-detector row computed tomography (CT) system may increase radiation exposure for infants because the irradiation range is wider than the planned range. The adaptive dose shield (ADS) prevents radiation exposure greater than the planned range. We examined the usefulness of the protection effect of the ADS for the infant inner ear CT. To confirm the protection effect of the ADS, we scanned X-ray films by using the 64-detector row CT system and measured the difference of the planned range and the irradiation range. The result of that is that when the planned range was small, the protection effect for the scan ending side was inferior to the scan starting side. And also, when the gantry rotation speed and pitch factor (PF) were high values, the protection effect was inferior to a low gantry rotation speed and low PF. There was a combination of gantry rotation speed and PF at which the protection effect decreases. Due to changes of the scanning direction and PF for the infant inner ear, the crystalline lens radiation exposure dose decreased from 11.89 mGy to 4.37 mGy. In conclusion, the ADS can reduce the radiation exposure dose of an adjacent organ. Therefore, it was thought that the ADS was a useful radiation exposure reduction function for infants in the 64-detector row CT system.

The value of 64-detector row computed tomography for the exclusion of pulmonary embolism

Recently, a diagnostic strategy using a clinical decision rule, D-dimer testing and spiral computed tomography (CT) was found to be effective in the evaluation of patients with clinically suspected pulmonary embolism (PE). However, the rate of venous thromboembolic complications in the three-month follow-up of patients with negative CT was still substantial and included fatal events. It was the objective to evaluate the safety of withholding anticoagulants after a normal 64-detector row CT (64-DCT) scan from a cohort of patients with suspected PE. A total of 545 consecutive patients with clinically suspected first episode of PE and either likely pre-test probability of PE (using the simplified Wells score) or unlikely pre-test probability in combination with a positive D-dimer underwent a 64-DCT. 64-DCT scanning was inconclusive in nine patients (1.6%), confirmed the presence of PE in 169 (31%), and ruled out the diagnosis in the remaining 367. During the three-month follow-up of the 367 patients one developed symptomatic distal deep-vein thrombosis (0.27%; 95%CI, 0.0 to 1.51%) and none developed PE (0 %; 95%CI, 0 to 1.0%). We conclude that 64-DCT scanning has the potential to safely exclude the presence of PE virtually in all patients presenting with clinical suspicion of this clinical disorder.

Whole-Brain Perfusion Measurement Using 320-Detector Row Computed Tomography in Patients With Cerebrovascular Steno-Occlusive Disease

The 320-detector row computed tomography (CT) can provide whole-brain CT perfusion (CTP) maps with continuous angiographic images by performing a single dynamic scan. We investigated the reliability of CTP cerebral blood flow (CTP-CBF) with 320-detector row CT by comparing findings with O-positron emission tomography (PET-CBF). Whole-brain CTP and PET were performed in 10 patients with chronic unilateral steno-occlusive disease. We compared absolute and relative CBF values of bilateral middle cerebral artery territories between CTP and PET. Although mean CTP-CBF values were approximately 30% lower than mean PET-CBF values, the mean ischemic-to-nonischemic CBF ratios of CTP and PET were almost identical (P = 0.804). Regression analysis showed a significant correlation between CTP-CBF and PET-CBF values for each patient (r = 0.52-0.85, P < 0.001). Whole-brain CTP using 320-detector row CT is useful for evaluating the degree of ischemia for the entire brain with chronic cerebrovascular disease.

Assessment of Non–Small Cell Lung Cancer Perfusion: Pathologic-CT Correlation in 15 Patients

To assess tumor perfusion with multi-detector row computed tomography (CT) in patients with non-small cell lung carcinoma and to correlate CT findings with pathologic results. This study was approved by the local Ethics Committee, and all patients provided written informed consent, which included information on the radiation exposure at the CT examinations. Fifteen consecutive patients (mean age, 60.5 years ± 7.7 [standard deviation]), including 14 men (mean age, 59.9 years ± 7.5) and one woman (age, 70 years) with histologically proved non-small cell lung carcinoma were prospectively enrolled. Overall, pathologic-CT correlations were examined in 31 focal tumoral zones. Comparative analysis was performed by using the χ(2) or the Fisher exact test for categoric data. For numeric data, group comparisons were performed by using the Mann-Whitney test. Whole-tumor coverage (mean height, 4.3 cm ± 2.1) was possible in all patients with generation of colored parametric maps of volume transfer constant (K(trans)) and blood volume (BV) by using Patlak analysis. Of the 12 areas that showed high BV, 10 (83%) had a high K(trans); in all 12 cases, the vascular score was high, confirming the presence of numerous tumoral vessels. Nineteen areas showed low BV; when observed concurrently with a high K(trans) (seven of 19), the mean vessel number per area was significantly higher than that seen in areas with low BV and low K(trans) (12 of 19) (P = .038), suggestive of tumoral vessels associated with high interstitial pressure. Whole-tumor perfusion analysis is technically feasible with 64-detector row CT, with two patterns suggestive of high tumoral vascularity. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100181/-/DC1.

Multi-detector row computer tomography findings of fibrous dysplasia in orbital bone

To evaluate the efficacy of multi-detector row CT (MDCT) findings in the diagnosis of fibrous dysplasia (FD) in orbital bone. The MDCT manifestations of 18 cases of FD in orbital bone (6 cases from the 458th hospital of PLA, 12 cases from the Zhongshan ophthalmic center of Sun Yat-Sen university) collected from April 2002 to August 2009 were reviewed. Six cases were confirmed by biopsy, 5 cases were confirmed by operation and postoperative pathology, the remaining 6 cases were confirmed based on typical CT findings. FD in orbital bone could be originated from monostotic single lesion (5 cases), monostotic multiple lesions (1 cases) or polyostotic multiple lesions (12 cases). Twelve lesions were originated in the frontal bone, 5 lesions in the sphenoid, 2 lesions in the ethmoid, 7 lesions in the temporal bone. MDCT is very important in the diagnosis and treatment strategy of FD in orbital bone correctly. It help identify the location and extension of the lesions based on the axial plane, coronal plane and sagittal plane view.

64-row MDCT perfusion of head and neck squamous cell carcinoma: technical feasibility and quantitative analysis of perfusion parameters

To evaluate the technical feasibility of 64-row computed tomography (CT) quantitative perfusion imaging of head and neck squamous cell carcinoma (SCC). Twenty-nine patients with a total of 29 pathologically proven SCC underwent a cine-mode CT perfusion acquisition covering the lesion site. The acquisition started 10 s after intravenous injection of iodinated contrast material and lasted 50 s. On a dedicated workstation, regions of interest (ROI) were traced within the SCC, on a healthy portion of tissue (H), and on the ipsilateral sternocleidomastoid muscle (M). Blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability-surface product (PS) were calculated. In SCC, BF, BV and PS were higher compared with H (p<0.0001, p=0.002 and p=0.004, respectively) and M (p<0.0001). Conversely, MTT was lower in SCC than in H (p=0.0009) and M (p=0.0003). All datasets were free from substantial motion artefacts and ROI misregistration phenomena. No substantial discomfort or adverse events were experienced by any of the patients. 64-row CT quantitative perfusion imaging allows head and neck SCC to be distinguished from normal tissues.

Clinical utility of multidetector row computed tomography for diagnosing spinal dural arteriovenous fistulas undiagnosed by magnetic resonance imaging

Two elderly patients with dural arteriovenous fistulas (AVF), the abnormal vessels of which were not presented on magnetic resonance imaging (MRI) are reported. Although spinal AVF was suspected from hyperintensity in the spinal cord, dilated vessels were not detected on MRI. Computed tomography (CT) angiography was performed with a 64-detector row multidetector row CT (MDCT) system in both cases. The draining dilated vein was observed in both cases and they were interpreted as perimedullary AVF. In case 1, axial scan and the dorsal section of the coronal view demonstrated continuity of the radiculomedullary artery and intercostal artery through the spinal branch at the left Th12 level. After intravascular embolization in case 1 and surgical treatment in case 2, neurological improvement was obtained in both cases. MRI findings suggestive of dural AVF have described that intradural perimedullary tortuous low signal intensities posterior to the spinal cord, known as flow void, on T(2)-weighted images is the most consistent. Recently, MDCT angiography confirmed the presence of a fistula previously suspected after MRI. There are no previous reports that describe cases of dural AVF diagnosed by MDCT angiography of which abnormal vessels were undetected by MRI images. MDCT can detect abnormal vessels which were not depicted on MRI. When dural AVF are suspected on MRI, MDCT angiography should be performed before selective angiography to diagnose.

The nursing of pre-examination of coronary angiograph by 320-row computed tomography

Objective To study the nursing of pre-examination of coronary angiograph by 320-row computed tomography. Methods By analysing relevant information of 116 cases,who have 320-row CT coronary angiography, we summarized the nursing care measurements before the inspection. Results With patient and meticulous care, all the cases were successful completion of inspection, obtained satisfying inspection results, and image quality met the evaluation standard. Moreover,there was not any complications occured. Conclusions The correct and effective care guidance is an important guarantee for successful coronary angiography. Key words: 320-row spiral CT(computed tomography); Coronary angiography; Care

Multi-Detector Row Computed Tomographic Evaluation of Bronchopleural Fistula

To evaluate the usefulness of multi-detector row computed tomography (CT) in the diagnosis of bronchopleural fistula (BPF) and to correlate CT features with clinical, bronchoscopic, and surgical findings. Twenty-four patients had a final diagnosis of BPF. Thin-section axial and coronal multiplanar reformation images from multi-detector row CT datasets were assessed by 2 radiologists in consensus. The CT direct sign of BPF was a fistulous tract between the bronchus or lung and pleural space. The indirect signs were air bubbles beneath the bronchial stump or suspected fistula. Computed tomography demonstrated fistulous tract (central type, 3; peripheral type, 11) or indirect signs of BPF (central type, 3; peripheral type, 6), whereas bronchoscopy demonstrated 2 fistula openings (all central type) and indirect signs of BPF (central type, 2; peripheral type, 1). Thin-section axial and multiplanar reformation images are helpful in the diagnosis of BPF. Multi-detector row CT can be an initial diagnostic modality of BPF.

Abolition of Respiratory-Motion Artifact in Computed Tomography Coronary Angiography with Ultrafast Examinations: A Comparison Between 64-row and 320-row Multidetector Scanners

Purpose To compare the incidence of respiratory artifact in computed tomography (CT) coronary angiography performed with 64-row and 320-row multidetector scanners and to assess its effect on coronary evaluability. Methods A retrospective review of consecutive coronary angiograms performed on a 64-row multidetector CT from March to April 2007 (group 1: 115 patients, 63 men; mean age [standard deviation] 59.6 ± 12.8 years) and on a 320-row multidetector CT from March to April 2008 (group 2: 169 patients, 89 men; mean [SD] age 57.9 ± 11.6 years). Two cardiac radiologists assessed the occurrence of respiratory artifact and coronary evaluability in studies with respiratory artifacts. Unevaluable coronary segments because of motion at the same anatomical level of the respiratory artifact were considered unevaluable because of this artifact. The association between the occurrence of respiratory artifact and patient biometrics, medication, and scan parameters was examined. Results Respiratory artifacts were detected in 9 of the 115 patients from group 1 (7.8%) and in none of the 169 patients from group 2 ( P < .001). Group 1 had longer scan times (median, 9.3 seconds; range, 7.5−14.4 seconds) compared with group 2 (median, 1.5 seconds; range, 1.1−3.5 seconds; P < .001). In group 1, 4 patients (3.5%) showed unevaluable coronary segments because of respiratory artifacts, and the CT coronary angiography was repeated in 1 patient (0.9%). Conclusions Respiratory artifacts are important in CT coronary angiography performed with 64-row multidetector scanners and impair the diagnostic utility of the examination in up to 3.5% of the studies. These artifacts can be virtually eliminated with a faster scan time provided by 320-row multidetector CT.

Comparison between 64-row CT angiography and digital subtraction angiography in the study of lower extremities: personal experience

This study was undertaken to evaluate the potential of 64-row multislice computed tomography (CT) versus digital subtraction angiography (DSA) in detecting significant lesions of lower-extremity inflow and runoff arteries. Fifty-three patients underwent 64-row multislice CT and DSA over a mean of 36 days. The vascular tree was divided into 33 segments. Three readers independently reviewed the axial CT scans and multiplanar oblique and two- and three-dimensional reconstructions (maximum intensity projection and volume rendering) images to assess degree of stenosis according to four categories: 1 (0%-49% stenosis); 2 (50%-99% stenosis); 3 (occluded); 4 (not evaluable). In all cases, DSA was performed by arterial catheterisation. In 53 patients, 1,440 segments were evaluated (infrarenal aorta and 16 arterial segments for each leg; 42 bilateral studies, 11 unilateral studies). Compared with DSA, CT angiography yielded 97.2% sensitivity, 97% specificity, 92.5% positive predictive value, 98.9% negative predictive value, 97.1% diagnostic accuracy and 95.4% concordance on the degree of stenosis. Sixty-four-row multislice CT proved to be helpful in detecting haemodynamically significant lesions in peripheral arterial occlusive disease and improved the results obtained with 4- and 16-slice multidetector CT. In addition, owing to the high spatial resolution and rigorous technique, no variations in the data obtained below the knee were detected, overcoming a limitation of earlier generations of CT scanners.

Clinical Summaries

Clinical Summaries

Carotid artery wall thickness: comparison between sonography and multi-detector row CT angiography

Prospective studies have shown that an increased thickness of the carotid wall is a significant predictor of coronary and cerebrovascular complications. Our purpose was to assess the agreement between multi-detector row computed tomography (CT) angiography (MDCTA) and colour Doppler ultrasound (CD-US) in measuring carotid artery wall thickness (CAWT) and the intima-media thickness (IMT). Altogether, 97 subjects (age range 64-84 years) were prospectively analysed using a four-detector row CT and a sonographic scanner. In total, 46 subjects had shown cerebral ischaemic symptoms. CAWT and IMT were measured in each patient using MDCTA and CD-US (by applying a digital calliper), respectively. Continuous data were described as the mean value +/- standard deviation and were compared using the Mann-Whitney U test. A p value <0.05 was considered significant. Bland-Altman statistics was employed to measure the agreement between MDCTA and CD-US. CAWT ranged from 0.5 to 1.53 mm, with a mean value of 0.9072 mm. IMT ranged from 0.46 to 1.5 mm, with a mean value of 0.8839 mm. By analysing the Bland-Altman plot, we observed an excellent agreement between CD-US and MDCTA with a bias between methods of 0.023 +/- 0.0424 mm. A limit of agreement from -0.06 to 0.106 was recorded. Correlation coefficient r was 0.9855 (95% confidence interval 0.9808-0.989). Mann-Whitney U test indicated a p value of 0.377. Obtained results indicated a significant agreement between MDCTA and CD-US in the measurement of CAWT and IMT.

Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy

Noninvasive coronary angiography with the use of multislice computed tomography (CT) scanners is feasible with high sensitivity and negative predictive value; however, the radiation exposure associated with this technique is rather high. We evaluated coronary angiography using whole-heart 320-row CT, which avoids exposure-intensive overscanning and overranging. A total of 30 consecutive patients with suspected coronary artery disease referred for clinically indicated conventional coronary angiography (CCA) were included in this prospective intention-to-diagnose study. CT was performed with the use of up to 320 simultaneous detector rows before same-day CCA, which, together with quantitative analysis, served as the reference standard. The per-patient sensitivity and specificity for CT compared with CCA were 100% (95% confidence interval [CI], 72 to 100) and 94% (95% CI, 73 to 100), respectively. Per-vessel versus per-segment sensitivity and specificity were 89% (95% CI, 62 to 98) and 96% (95% CI, 90 to 99) versus 78% (95% CI, 56 to 91) and 98% (95% CI, 96 to 99), respectively. Interobserver agreement between the 2 readers was significantly better for CCA (97% of 121 coronary arteries) than for CT (90%; P=0.04). Percent diameter stenosis determined with the use of CT showed good correlation with CCA (P<0.001, R=0.81) without significant underestimation or overestimation (-3.1+/-24.4%; P=0.08). Intraindividual comparison of CT with CCA revealed a significantly smaller effective radiation dose (median, 4.2 versus 8.5 mSv; P<0.05) and amount of contrast agent required (median, 80 versus 111 mL; P<0.001) for 320-row CT. The majority of patients (87%) indicated that they would prefer CT over CCA for future diagnostic imaging (P<0.001). CT with the use of emerging technology has the potential to significantly reduce the radiation dose and amount of contrast agent required compared with CCA while maintaining high diagnostic accuracy.

Multidetector row CT urography: does supine or prone positioning produce better pelvecalyceal and ureteral opacification?

Purpose To evaluate whether supine or prone positioning improves pelvicalyceal and ureteral opacification at multi-detector row computed tomographic (CT) urography. Methods We retrospectively reviewed the CT urograms of 114 consecutive patients performed for hematuria. Using a “split-bolus” technique, all patients were imaged 340 s after the injection of intravenous contrast, 63 in the supine and 51 in the prone position. The right and left pelvicalyceal systems and ureters were divided into six segments: anterior calyces, posterior calyces, renal pelvis, proximal ureter, mid ureter, and distal ureter. Two readers rated the opacification of each segment in consensus on a four-point scale from 0 (no opacification) to 3 (excellent opacification). Opacification scores were compared between supine and prone CT urograms using generalized estimating equation models. Results Supine positioning resulted in higher opacification scores of the renal pelvis and the posterior calyces than prone positioning ( P<.01). Prone positioning resulted in higher opacification scores of the anterior calyces only ( P<.01). No significant differences were seen between the supine and prone opacification scores for the proximal, mid, or distal ureters ( P values all >.5). Conclusion Supine positioning results in overall greater opacification of the pelvicalyceal system compared to prone positioning at CT urography.

Diagnostic Imaging of Patients in a Memory Clinic: Comparison of MR Imaging and 64–Detector Row CT

To investigate the assessment of global cortical atrophy (GCA), medial temporal lobe atrophy (MTA), and white matter changes (WMCs) in patients screened at a memory clinic with a 64-detector row computed tomography (CT) brain protocol, in comparison with the reference standard, magnetic resonance (MR) imaging. The study protocol was approved by the local institutional review board. Written informed consent was obtained from all participants. Thirty patients (21 men, nine women; median age, 62 years) who presented to a memory clinic underwent 64-detector row CT and multisequence MR imaging of the brain on the same day. Three readers blinded to the clinical diagnosis assessed the resultant images. Images were presented in random order and scored for GCA, MTA, and WMC with published visual rating scales. Intermodality agreement between CT and MR imaging (intrareader agreement across both modalities), expressed by weighted kappa analysis, and interobserver agreement within each modality between readers (Kendall W test) were assessed. Overall, excellent intraobserver agreement between CT and MR imaging was observed for GCA (mean kappa, 0.83) and MTA (mean kappa, 0.88 and 0.86 on the left and right sides of the brain, respectively). There was substantial overall agreement concerning WMC (mean kappa, 0.79). For all three tested scales, interobserver variability was low and comparable for CT and MR imaging. Use of 64-detector row brain CT yields reliable information that is comparable with that obtained with MR imaging. Thus, multidetector row CT is a suitable diagnostic imaging tool in a memory clinic setting.

SU‐FF‐I‐24: Scan Time and Patient Dose for Thoracic Imaging in Neonates and Small Children Using Axial Volumetric 320‐Detector Row CT Compared to Helical 64‐, 32‐, and 16‐ Detector Row CT Acquisitions

Purpose: To evaluate scan time and patient dose for axial cone beam thoracic imaging in neonates and small children by phantom study with a 320‐detector row computed tomography (CT) scanner compared to helical multi‐detector row CT (MDCT) acquisitions. Method and Materials: Acquisition parameters that yield similar image quality were derived for standard thoracic scan protocols with volumetric 320‐MDCT and with helical 64‐, 32‐ and 16‐MDCT. The weighted CT dose index (CTDI300w) was derived from measurements with a 300 mm long CT pencil ionization chamber (CT‐110, Applied Engineering Inc., Japan) in an extended 350 mm long CT dose head phantom (diameter 160 mm). Dose length product (DLP, mGy⋅cm) was derived from the measured CTDI300w. Scan ranges of 80 mm, 120 mm, and 160 mm were considered. The paired t‐test was used to determine statistical differences in radiation exposure between the scan modes. Results: Scan time was 0.35s (one full rotation) for 320‐MDCT acquisitions; scan times varied between 1.9s and 8.3s for helical acquisitions (respectively 80 mm helical 64‐MDCT and 160 mm helical 16‐MDCT). Patient radiation dose savings varying between 18% and 40% were achieved with volumetric scanning as compared to helical scanning. Mean dose saving for 320‐MDCT versus 64‐MDCT was 25% (p &lt; 0.001); versus 32‐MDCT was 28% (p&lt; 0.001), and versus 16‐MDCT was 33% (p &lt; 0.001). The smaller the selected scan range was; the higher the achieved dose reductions were. A clinical case wil be presented. A 4‐weeks‐old 3.5 kg male patient was scanned with axial volumetric 320‐MDCT. The dose length product (DLP) was 16.6 mGy⋅cm (based on CTDI300w), estimated effective dose was 0.65 mSv. Conclusion: Axial thoracic CT of neonates and small children with volumetric 320‐MDCT can be performed 5 to 24 times faster compared to helical scanning and saves between 18% and 40% in patient dose.

Multidetector row CT of the brain and carotid artery: a correlative analysis

To evaluate the association between types of carotid plaque, the presence of prior ischaemic events detectable with CT, and patient's symptoms. Between January 2004 and May 2006, 112 patients were evaluated using multidetector row computed tomography angiography (MDCTA) of the carotid arteries and computed tomography (CT) of the brain. Carotid arteries were categorized by evaluating the degree of stenosis according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, the type of plaque, and the presence of plaque ulceration. The brain was assessed via CT for the presence, type, and position of lesions. Chi-square tests, Student's t test, and simple logistic regression analysis were performed and the Cohen kappa test was applied for interobserver variability measurement. The Chi-square test indicated a statistically significant association between the presence of fatty plaques (p=0.005) and CT-detectable lesions in the brain (p=0.004). Moreover, the number of patients with CT-detectable brain lesions was greater in patients with >70% stenosis than in those with <70% stenosis (p=0.007). Logistic regression confirmed the association between fatty plaque and symptoms (p=0.001), between >70% stenosis and symptoms (p=0.041), and an inverse association between calcified plaque and symptoms (p=0.009). MDCTA allows adequate evaluation of the type of plaque. The results of the present study indicate that there is an association between cerebral lesions, symptoms, and fatty plaque in the carotid artery. The degree of stenosis also correlated with cerebral lesions and symptoms. According to the obtained data, the type of carotid plaque should be included among primary parameters in the classification of patients' risk class.

64-Section multi-detector row CT in the preoperative diagnosis of peritoneal carcinomatosis: correlation with histopathological findings

To prospectively investigate the diagnostic accuracy of a 64-section multi-detector row computed tomography (CT) for the detection of peritoneal metastases, with the use of surgery and histopathological findings as the reference standard. The study cohort comprised 18 patients with peritoneal carcinomatosis who underwent multiphasic CT with a 64-section CT, 0-119 days before cytoreductive surgery. Transverse CT images along with isotropic reformatted coronal and sagittal images were prospectively and independently evaluated by one of the five staff radiologists in an unblinded fashion. The overall sensitivity, specificity, positive, and negative predictive values of CT for the detection of peritoneal metastases were, respectively, 75% (93 of 124 lesions; confidence interval [CI] 68-84), 92% (118 of 128; CI 85-96), 90% (93 of 103; CI 83-95), and 79% (118 of 149; CI 72-86). For lesions 0.5 cm in diameter or larger, CT yielded a mean sensitivity of 89% (77 of 87; CI 75-97), although sensitivity decreased to only 43% (16 of 37; CI 28-56) for lesions <0.5 cm in diameter. 64-Section CT with the addition of isotropic reformatted coronal and sagittal images is a very effective technique in the detection of peritoneal metastases of 0.5 cm in diameter or larger, although sensitivity decreases remarkably for lesions <0.5 cm in diameter.

Plain Radiography Does Not Add Any Clinically Significant Advantage to Multidetector Row Computed Tomography in Diagnosing Cervical Spine Injuries in Blunt Trauma Patients

Cervical spine (c-spine) injuries (CSI) in trauma patients are common and potentially catastrophic. Numerous guidelines involving clinical and radiologic criteria have been devised to diagnose such injuries. It is not clear whether using plain X-ray films in addition to helical computed tomography (CT) provides any additional benefit in trauma patients who require radiologic clearance of their c-spine. We hypothesized that three standard X-ray views (anteroposterior, lateral, and odontoid) of the c-spine do not provide clinically significant advantage to Multidetector row CT in diagnosing CSI in trauma patients. We reviewed the charts of consecutive adult patients with CSI who were admitted to the Trauma Service at a Level I Trauma Center between January 2001 and December 2004. Patients who had CT plus X-ray at admission were entered into the study. Exclusion criteria were age < or = 16 years, incomplete radiology reports, inadequate plain films, or no CSI identified. A total of 121 patients with diagnosed CSI were included in the study. CT picked up 100% of patients who had a CSI diagnosed on plain films and also detected 47 additional CSI that were missed by plain films. The sensitivity for CT was 100%, whereas that of plain films was 61%. Nine patients with CSI (19.1%) who had false-negative plain films required operative intervention. Three standard X-ray views of the c-spine provided no clinically significant advantage to Multidetector row CT in diagnosing CSI. Revision of current clinical guidelines on c-spine clearance is recommended.