Cervical Computed Tomography Scan Research Articles

Whole Body Imaging in Blunt Multisystem Trauma Patients Without Obvious Signs of Injury

The use of liberal whole body imaging (pan scan) in patients based on mechanism is warranted, even in evaluable patients with no obvious signs of chest or abdominal injury. Prospective observational study. Academic level I trauma center. All patients admitted following blunt multisystem trauma. Pan scan, including computed tomography (CT) of the head, cervical spine, chest, abdomen, and pelvis, with the following inclusion criteria: (1) no visible evidence of chest or abdominal injury, (2) hemodynamically stable, (3) normal abdominal examination results in a neurologically intact patient or unevaluable abdominal examination results secondary to a depressed level of consciousness, and (4) significant mechanisms of injury. Radiological findings and changes in treatment based on these findings were recorded. Any alteration in the normal treatment plan as a direct result of CT scan findings. These alterations include early hospital discharge, admission for observation, operative intervention, and additional diagnostic studies or interventions. One thousand patients underwent pan scan during the 18-month observation period, of which 592 were evaluable patients with no obvious signs of abdominal injury. Clinically significant abnormalities were found in 3.5% of head CT scans, 5.1% of cervical spine CT scans, 19.6% of chest CT scans, and 7.1% of abdominal CT scans. Overall treatment was changed in 18.9% of patients based on abnormal CT scan findings. The use of pan scan based on mechanism in awake, evaluable patients is warranted. Clinically significant abnormalities are not uncommon, resulting in a change in treatment in nearly 19% of patients.

Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy

Background To determine the safety and effectiveness of the use of titanium mesh cages (TMCs) and anterior cervical plates (ACPs) for interbody fusion after anterior cervical corpectomy. Methods From June 2001 to June 2003, 15 patients underwent reconstruction with TMCs and ACPs for interbody fusion after anterior cervical corpectomy in our hospital. The mean follow-up is 13.6 months (range, 9-24 months). Subjects included those with cervical degenerative, traumatic, or pathological diseases. Titanium mesh cages were filled with autologous bone grafts taken from the corpectomy and iliac crest bone chips and were all filled with triosite (calcium phosphate ceramics). The patients' observable signs, neurological reconstruction results, and complications were fully and explicitly recorded throughout the procedure. Radiological imaging studies for measurements of coronal and sagittal angles, sagittal displacements, and settling ratio changes were performed to evaluate spinal stability. We used axial cervical computed tomography (CT) and reconstructive sagittal cervical CT to demonstrate interbody fusion within titanium mesh. Results The alleviation and frequent disappearance of the subjects' original symptoms and the significant neurological recovery obvious in most patients indicated that postoperative spinal stability could be well maintained. No significant differences in mean cage height–related settling rates, mean sagittal displacements, and mean coronal and sagittal angle changes were observed between 1-level and multilevel corpectomy. All patients who received axial and reconstructive sagittal cervical CT scan could demonstrate true interbody fusion within TMC, and no nonunions were present. Cage malplacement was observed in one subject who had neck pain and neck stiffness, rather than from radiculopathy or myelopathy. One subject died of acute myocardial infarction. There were no ceramic-related complications. Conclusions Based on preliminary findings from this study, reconstruction involving TMC interbody fusion with ACP fixation after anterior cervical corpectomy serves as an effective and safe method for the treatment of cervical disease.

The Inefficiency of Plain Radiography to Evaluate the Cervical Spine After Blunt Trauma

Controversy persists regarding the most efficient and effective method of cervical spine evaluation after blunt trauma. Historic guidelines for patients undergoing computed tomography (CT) of the head advocate imaging the occiput-C2 as part of that study. For the remaining cervical spine, plain cervical spine radiographs (CSR) with supplemental CT are recommended. Many patients who require head CT also undergo supplemental cervical spine CT after plain CSR, which leads to separate, discontinuous cervical spine CT scans. We sought to determine the incidence of this in our population. We hypothesized that plain CSR alone often proves inadequate to evaluate the cervical spine in patients who require head CT. The Eastern Association for the Surgery of Trauma (EAST) guidelines for cervical spine evaluation after blunt trauma were previously adopted and followed during the study period from December 1, 2002 to July 1, 2003. Our protocol included cross-table lateral and anteroposterior CSR with the occiput-C2 imaged with the head CT. We used segmental cervical spine CT to supplement those regions inadequately visualized by plain films. The electronic charts of 848 consecutive blunt trauma victims were retrospectively reviewed. The data abstracted included demographics, injury severity score, and the use and results of head CT and radiographic evaluation of the cervical spine. Of 848 consecutive blunt trauma patients, 716 (84.4%) underwent head CT. Average age was 44 years old, and average Injury Severity Score was 9. Seventy-six patients (11.6%) had clinical cervical spine examination alone, whereas 640 (89.4%) underwent plain CSR. In 178 patients (27.8%), plain two-view CSR visualized the entire cervical spine. Plain CSR were inadequate to visualize the complete cervical spine in 462 patients (72.2%). Of these patients, segmental CT was performed in 400 (87.6%). The remaining 62 (13.4%) patients did not have radiologic completion of their cervical spine evaluation before clinical examination. Nineteen patients (3.0%) had cervical spine fractures diagnosed on CT, of which only 6 (31.6%) were seen on plain CSR. The sensitivity and specificity of CSR to detect fractures was 31.6 and 99.2%, respectively. Plain CSR are inadequate to fully evaluate the cervical spine after blunt trauma, and supplemental CT is commonly required. Complete cervical spine CT is available, efficient, and accurate. Our findings support a growing body of literature that suggests that this modality should be used for blunt trauma patients who require radiographic evaluation of the cervical spine. Plain cervical spine radiographs need not be obtained. The EAST guidelines for cervical spine evaluation after blunt trauma should be updated to reflect this evolving practice pattern.

Endoscopic ultrasonography in the diagnosis and staging of neoplasms of the head and neck.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a minimally invasive and highly accurate method of detecting mediastinal lymph-node metastases in gastrointestinal and lung cancer. Little information is available regarding the use of EUS-FNA to stage tumors in the head and neck region. This study reports experience with EUS in the diagnosis and staging of these tumors and their mediastinal spread. The records of patients who underwent EUS for diagnosis and/or staging of head and neck tumors were reviewed. Referral criteria were suspected invasion of the esophagus by a lower-neck mass on cervical computed tomography (CT) or magnetic resonance imaging (MRI), or mediastinal lymphadenopathy > 10 mm on a chest CT. Thirty-two patients (23 men, nine women; mean age 65 years, range 44 - 80) were referred and underwent 35 EUS examinations. In one patient, EUS was not possible due to a benign esophageal stricture. In 17 patients with suspected esophageal invasion on CT scans, EUS demonstrated invasion of the esophagus in four cases and of the pleura in one; 12 tumors showed no visible invasion of adjacent structures. The other 17 examinations were carried out for suspected mediastinal metastatic disease. In eight cases, EUS-FNA confirmed metastatic disease, whereas only benign changes were shown in the other nine cases. EUS-FNA also provided the first tissue diagnosis in two primary tumors and identified malignancy in one patient with no CT suspicion of positive mediastinal lymph nodes. EUS avoided the need for more invasive investigations in all patients with mediastinal lymphadenopathy, and it changed the management in 12 of the 17 patients (71 %) with suspected esophageal invasion and in eight of the 17 patients (47 %) with suspected mediastinal disease. EUS with FNA provides a viable approach to the diagnosis and staging of tumors in the head and neck region when there is a suggestion of esophageal invasion on CT or MRI, or enlarged mediastinal lymph nodes. EUS with FNA may avoid the need for mediastinoscopy or other more invasive techniques for staging of these neoplasms.

The cricoid cartilage and the esophagus are not aligned in close to half of adult patients.

To determine the frequency and degree of lateral displacement of the esophagus relative to the cricoid cartilage ("cricoid") using computed tomography (CT) images of normal necks. Fifty-one cervical CT scans of clinically normal patients were reviewed retrospectively. Esophageal diameter, distance between the midline of the cricoid and the midline of the esophagus, and distance between the lateral border of the cricoid and the lateral border of the esophagus were measured. Lateral esophageal displacement was observed in 49% (25/51) of CT images. When present, the mean length of displaced esophagus relative to the midline of the cricoid was 3.3 mm +/- SD 1.3 mm. Of those with lateral displacement, 64% had esophageal displacement beyond the lateral border of the cricoid (mean 3.2 mm +/- SD 1.2 mm). There is a relatively normal distribution of the grouped measures of percentage of esophageal diameter that is displaced. Of those with displacement, 48% had over 15% of the total width of the esophagus displaced laterally and 20% had over 20% of the esophageal width displaced laterally. There is a 49% frequency of some degree of lateral displacement of the esophagus relative to the cricoid.

Primary pediatric neuroblastic tumors of the neck

Neuroblastic tumors are the third most common cause of solid tumors in early childhood. Cervical tumors account for only 5% of cases. In this report, we describe a series of four pediatric neuroblastic tumors of the neck. The histological diagnosis was ganglioneuroblastoma in three cases and neuroblastoma in one case. Presenting signs were solitary cervical mass in two cases and respiratory distress in association with Claude-Bernard Horner's syndrome in two cases. Mean age at presentation was 15 months. Cervical computed tomography scan and/or magnetic resonance imaging depicted calcifications within the tumor in 50% of cases and allowed accurate assessment of extension. Increased urine catecholamine levels were observed only in the patient with neuroblastoma. Scintigraphy with [131]iodine-methyliodobenzylguanidine demonstrated selective uptake by the tumor in two cases. Amplification of N-myc oncogene, a documented unfavorable prognostic sign, was not found in any case. Surgical treatment was performed in all patients. Neoadjuvant chemotherapy was performed in one case. All patients underwent regular surveillance. No evidence of recurrence has been observed with a mean follow-up period of 7 years.

Computed tomography diagnosis of esophageal bone impaction: a prospective study.

A prospective study was performed on 45 patients for an assessment of the use of computed tomography (CT) in the management of a suspected esophageal fish bone or chicken bone. All patients had negative findings on laryngoscopy; therefore, pharyngeal and hypopharyngeal foreign bodies were excluded from further consideration. The patients underwent radiographic examination with plain films and a cervical CT scan without contrast material. Patients with positive findings were taken to the operating room, where they underwent rigid esophagoscopy under general anesthesia, while those with negative findings remained for observation for 24 hours. Thirty CT scans were positive for an esophageal foreign body, and in all cases but 1, a foreign body was found during the operation. Fourteen of 15 patients with normal CT scan findings managed well with no further intervention. One patient with persistent complaints underwent esophagoscopy, but no foreign body was found. Our conclusion is therefore that CT is a simple and reliable method for diagnosing esophageal bone impaction and may reduce the rate of unnecessary esophagoscopies.

Fiberoptic Intracranial Pressure Monitoring during Magnetic Resonance Imaging

Fiberoptic Intracranial Pressure Monitoring during Magnetic Resonance Imaging

Giant cell tumor in cervical spine

A giant cell tumor in the cervical spine of a 67-year-old man complaining of pain in the neck and occipital area is reported. Cervical x-ray films revealed a round destructive lesion in the vertebral body of the fourth cervical vertebra. On the plain cervical computed tomography scan, the most impressive finding was a soap-bubble appearance, which showed a linear high-density area in the mass lesion with destruction of the vertebral body. After embolizing one branch of the artery feeding the tumor, a radical operation was carried out via the anterior approach. The role of cervical computed tomography scanning and computed tomographic myelography in diagnosing and showing the extension of the giant cell tumor is discussed.