Use of coronal reconstructions of multi slice ct in ed pacs to rule out artifact odontoid fracture cause of unneeded surgery

Use of Coronal reconstructions of multi slice CT in ED-PACS to rule out artifact odontoid fracture: Cause of unneeded surgery.

Dr. Anil kumar kothiwalaDr. Deepak Agarwal

Department of Neurosurgery, JPNATC, AIIMS, New Delhi

Introduction • Modern CT alone is sufficient to detect unstable cervical

spine injuries in trauma patients.The sensitivity and specificity for modern CT were both > 99.9%.

• However artifacts may lead to false diagnoses.

• Mostly sagittal and axial cuts are checked to rule out cervical spine injury and coronal reconstructions are rarely used in printed CT films.

• Use of ED-PACS with easy sharing of coronal reconstruction can be useful to rule out artifact odontoid fracture and prevent repeat imaging and unneeded surgery.

Case 1

Case 1

Sagittal images are suggestive of odontoid fracture, and axial images are suggestive of motion artifact. However coronal reconstruction suggests no evidence of fracture and dislocation of dens.

Case 2

Case 2

• Similar to case 1 Sagittal images are suggestive of type II odontoid fracture, and axial images are suggestive of motion artifact.

• However coronal reconstruction suggests no evidence of fracture and dislocation of dens.

• MRI Cervical spine and repeat CT was done in both the cases.

• Retrospectively Initial CT cervical scan were observed.

• Coronal reconstructions are useful in ruling out Artifact odontoid fracture.

• Cervical collar can be removed if coronal reconstructions do not show odontoid fracture.

Discussion• Meta-analysis shows that the sensitivity and

specificity for modern CT were both > 99.9%.• Results of this meta-analysis strongly show that the

cervical collar can be removed from obtunded or intubated trauma patients if a modern CT scan is negative for acute injury.

J Neurosurg. 2011 Sep;115(3):541-9.• Computed tomography (CT) examination even

more valuable in polytrauma patients for suspected thoracoabdominal injuries.

Pseudo trauma of spine

Carr et al. AJR:199, December 2012

Matthew crocker et al., (2009)

Matthew Crocker, Helen Matthews , Charles Willis-Owen, Saffron Willis-Owen, Philip Rich, Pawan Minhas. Movement artifact mimicking type 2 odontoid fracture on CT reconstructions. Injury Extra, Volume 40, Issue 4, Pages 63-64 , 2009.

Yoshihisa Sugimoto et al., (2012)

Yoshihisa Sugimoto, Yasuo Ito, Yasuyuki Shiozaki, Tetsuya Shimokawa, Tetsuro Mazaki. Motion Induced Artifact Mimicking Cervical Dens Fracture on the CT Scan: A Case Report. ASJ: Vol.6, No.3, pp 216-218, 2012.

• Similar to our cases In both the reported cases

repeat CT scan and MRI was done. • Repeat studies doesn’t show any evidence of

odontoid fracture.• We retrospectively analyzed initial CT scans of

these two patients.• We found that Coronal imaging on first attempt can

rule out artifact fracture of odontoid.