Abstract
Purpose
This study aims to determine the normal limits of atlanto-dental interval (ADI), basion-dens interval (BDI), basion-cartilaginous dens interval (BCDI), and prevertebral soft tissue thickness (PVSTT) according to age groups for normal pediatric cases.
Materials and methods
CT images of 256 pediatric patients aged between 1 and 15 years were retrospectively evaluated. ADI, BDI, BCDI and PVSTT measurements were performed.
Results
Upper normal limit (UNL) values for ADI were 2.65–4.8 mm. UNL values for PVSTT were found to be 6.9 mm at C1 level, 6.7 mm at C2 level, 9.3 mm at C3 level, 14.2 mm at C4 level, 14.1 mm at C5 level, 13.8 mm at C6 level and 12.8 mm at C7 level. The maximum value of BDI in the group with non-ossified os terminale was 12 mm, and in the group with ossified os terminale it was 10 mm. The UNL of BCDI determined for females was 5.1 mm, while the UNL for males was 5.6 mm.
Conclusion
We propose the obtained values as the UNL values for ADI, BDI, BCDI and PVSTT on CT images in the pediatric population from 1 to 15 years.
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References
Dietrich AM, Ginn-Pease ME, Bartkowski HM, King DR. Pediatric cervical spine fractures: predominantly subtle presentation. J Pediatr Surg. 1991;26:995–9.
Kokoska ER, Keller MS, Rallo MC, Weber TR. Characteristics of pediatric cervical spine injuries. J Pediatr Surg. 2001;36:100–5.
Goldstein HE, Anderson RCE. Classification and Management of pediatric craniocervical injuries. Neurosurg Clin N Am. 2017;28:73–90.
Junewick JJ. Pediatric craniocervical junction injuries. AJR. 2011;196:1003–10.
Singh AK, Fulton Z, Tiwari R, Zhang X, Lu L, Altmeyer WB, et al. Basion-cartilaginous dens interval: an imaging parameter for craniovertebral junction assessment in children. AJNR. 2017;38:2380–4.
Patel JC, Tepas JJ 3rd, Mollitt DL, Pieper P. Pediatric cervical spine injuries: defining the disease. J Pediatr Surg. 2001;36:373–6.
Anderson RC, Scaife ER, Fenton SJ, Kan P, Hansen KW, Brockmeyer DL. Cervical spine clearance after trauma in children. J Neurosurg. 2006;105:361–4.
Vermess D, Rojas CA, Shaheen F, Roy P, Martinez CR. Normal pediatric prevertebral soft-tissue thickness on MDCT. AJR. 2012;199:130–3.
Bertozzi JC, Rojas CA, Martinez CR. Evaluation of the pediatric craniocervical junction on MDCT. AJR. 2009;192:26–31.
Harris J Jr. The cervicocranium: its radiographic assessment. Radiology. 2001;218:337–51.
Rojas CA, Vermess D, Bertozzi JC, Whitlow J, Guidi C, Martinez CR. Normal thickness and appearance of the prevertebral soft tissues on multidetector CT. AJNR. 2009;30:136–41.
Platzer P, Jaindl M, Thalhammer G, Dittrich S, Wieland T, Vecsei V, et al. Clearing the cervical spine in critically injured patients: a comprehensive C-spine protocol to avoid unnecessary delays in diagnosis. Eur Spine J. 2006;15:1801–10.
Wholey MH, Bruwer AJ, Baker HL Jr. The lateral roentgenogram of the neck: with comments on the atlanto-odontoid-basion relationship. Radiology. 1958;71:350–6.
Diaz JJ, Aulino JM, Collier B, Roman C, May AK, Miller RS, Guillamondegui O, et al. The early work-up for isolated ligamentous injury of the cervical spine: does computed tomography scan have a role? J Trauma. 2005;59:897–903.
Omercikoglu S, Altunbas E, Akoglu H, Onur O, Denizbasi A. Normal values of cervical vertebral measurements according to age and sex in CT. Am J Emerg Med. 2017;35:383–90.
Bagley LJ. Imaging of spinal trauma. Radiol Clin North Am. 2006;44:1–12.
Fayad LM, Corl F, Fishman EK. Pediatric skeletal trauma: use of multiplanar reformatted and three-dimensional 64-row multidetector CT in the emergency department. RadioGraphics. 2009;29:135–50.
Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, Vaheesan K, et al. Pediatric cervical spine: normal anatomy, variants, and trauma. RadioGraphics. 2003;23:539–60.
Keenan HT, Hollingshead MC, Chung CJ, Ziglar MK. Using CT of the cervical spine for early evaluation of pediatric patients with head trauma. AJR. 2001;177:1405–9.
Goradia D, Linnau KF, Cohen WA, Mirza S, Hallam DK, Blackmore CC. Correlation of MR imaging findings with intraoperative findings after cervical spine trauma. AJNR. 2007;28:209–15.
Parizel PM, van der Zijden T, Gaudino S, Spaepen M, Voormolen MHJ, Venstermans C, et al. Trauma of the spine and spinal cord: imaging strategies. Eur Spine J. 2010;19:8–17.
Radcliff KE, Ben-Galim P, Dreiangel N, Martin SB, Reitman CA, Lin JN, et al. Comprehensive computed tomography assessment of the upper cervical anatomy: what is normal? Spine J. 2010;10:219–29.
Rampersaud RY, Fehlings MG, Harrop JS, Kuklo T, Massicotte E, Salonen D, et al. Validation of digital radiology measurement tools for quantitative spinal imaging. Top Spinal Cord Inj Rehabil. 2006;12:11–21.
Stevens PM. Radiographic distortion of bones: a marker study. Orthopedics. 1989;12:1457–63.
Templeton PA, Young JW, Mirvis SE, Buddemeyer EU. The value of retropharyngeal soft tissue measurements in trauma of the adult cervical spine: cervical spine soft tissue measurements. Skeletal Radiol. 1987;16:98–104.
Ravi B, Rampersaud R. Clinical magnification error in lateral spinal digital radiographs. Spine. 2008;33:311–6.
Locke GR, Gardner JI, Van Epps EF. Atlas-dens interval (atlantodental interval) in children: a survey based on 200 normal cervical spines. Am J Roentgenol Radium Ther Nucl Med. 1966;97:135–40.
Brockmeyer DL, Ragel BT, Kestle JR. The pediatric cervical spine instability study. A pilot study assessing the prognostic value of four imaging modalities in clearing the cervical spine for children with severe traumatic injuries. Childs Nerv Syst. 2012;28:699–705.
Rojas CA, Bertozzi JC, Martinez CR, Whitlow J. Reassessment of the craniocervical junction: normal values on CT. AJNR. 2007;28:1819–23.
Hankinson TC, Anderson RC. Craniovertebral junction abnormalities in down syndrome. Neurosurgery. 2010;66:32–8.
Brockmeyer D. Down syndrome and craniovertebral instability. Topic review and treatment recommendations. Pediatr Neurosurg. 1999;31:71–7.
Harris JH Jr, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation, 1: normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR. 1994;162:881–6.
Gonzalez LF, Fiorella D, Crawford NR, Wallace RC, Feiz-Erfan I, Drumm D, et al. Vertical atlantoaxial distraction injuries: radiological criteria and clinical implications. J Neurosurg Spine. 2004;1:273–80.
Bulas DI, Fitz CR, Johnson DL. Traumatic atlanto-occipital dislocation in children. Radiology. 1993;188:1555–8.
Vachhrajani S, Sen AN, Satyan K, Kulkarni AV, Birchansky SB, Jea A. Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group. J Neurosurg Pediatr. 2014;14:425–33.
Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation–part 2: the clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery. 2007;61:995–1015.
Mullin TI, Wang M, Rao RD. Radiographic characterization of prevertebral soft tissue shadow in the cervicothoracic region of normal adults. J Surg Res. 2013;180:73–9.
Ozturk I, Bulut S, Atalar MH, Salk I, Ozum U. Evaluation of the prevertebral soft tissue thickness by magnetic resonance imaging in patients with mild neck problem. Turk Neurosurg. 2013;23:758–63.
Penning L. Prevertebral hematoma in cervical spine injury: incidence and etiologic significance. AJR. 1981;136:553–61.
Xue Z, Antani S, Long LR, Demner-Fushman D, Thoma GR. Window classification of brain CT images in biomedical articles. AMIA Annu Symp Proc. 2012;2012:1023–9.
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The authors declare that they have no conflict of interest to the publication of this article. This manuscript describes original work and is not under consideration by any other journal. All authors approved the manuscript and this submission. Necessary research ethics committee approvals were obtained. Measurements in Cervical Vertebrae CT of Pediatric Cases: Normal Values.
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The work originated in Health Sciences University Diskapi Yildirim Beyazit Research and Training Hospital, Sehit Omerhalisdemir Street, Diskapi, Ankara.
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Akturk, Y., Ozbal Gunes, S. Measurements in cervical vertebrae CT of pediatric cases: normal values. Jpn J Radiol 36, 500–510 (2018). https://doi.org/10.1007/s11604-018-0749-9
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DOI: https://doi.org/10.1007/s11604-018-0749-9