PMID- 34184931
OWN - NLM
STAT- MEDLINE
DCOM- 20211011
LR  - 20211011
IS  - 1527-1315 (Electronic)
IS  - 0033-8419 (Linking)
VI  - 300
IP  - 3
DP  - 2021 Sep
TI  - Diagnostic Benefit of MRI for Exclusion of Ligamentous Injury in Patients with 
      Lateral Atlantodental Interval Asymmetry at Initial Trauma CT.
PG  - 633-640
LID - 10.1148/radiol.2021204187 [doi]
AB  - Background Cervical spine CT is regularly performed to exclude cervical spine 
      injury during the initial evaluation of trauma patients. Patients with asymmetry 
      of the lateral atlantodental interval (LADI) often undergo subsequent MRI to rule 
      out ligamentous injuries. The clinical relevance of an asymmetric LADI and the 
      benefit of additional MRI remain unclear. Purpose To evaluate the diagnostic 
      benefit of additional MRI in patients with blunt trauma who have asymmetry of the 
      LADI and no other cervical injuries. Materials and Methods Patients who underwent 
      cervical spine CT during initial trauma evaluation between March 2017 and August 
      2019 were retrospectively evaluated. Those who underwent subsequent MRI because 
      of LADI asymmetry of 1 mm or greater with no other signs of cervical injury were 
      identified and reevaluated by two readers blinded to clinical data and initial 
      study reports regarding possible ligamentous injuries. Results Among 1553 
      patients, 146 (9%) had LADI asymmetry of 1 mm or greater. Of these, 46 patients 
      (mean age +/- standard deviation, 39 years +/- 22; 28 men; median LADI asymmetry, 2.4 
      mm [interquartile range, 1.8-3.1 mm]) underwent supplementary MRI with no other 
      signs of cervical injury at initial CT. Ten of the 46 patients (22%) showed 
      cervical tenderness at clinical examination, and 36 patients (78%) were 
      asymptomatic. In two of the 46 patients (4%), MRI revealed alar ligament injury; 
      both of these patients showed LADI asymmetry greater than 3 mm, along with 
      cervical tenderness at clinical examination, and underwent treatment for 
      ligamentous injury. In 13 of the 46 patients (28%), signal intensity alterations 
      of alar ligaments without signs of rupture were observed. Four of these 13 
      patients (31%) were subsequently treated for ligamentous injury despite being 
      asymptomatic. Conclusion Subsequent MRI following CT of the cervical spine in 
      trauma patients with lateral atlantodental interval asymmetry may have diagnostic 
      benefit only in symptomatic patients. In asymptomatic patients without proven 
      cervical injuries, subsequent MRI showed no diagnostic benefit and may even lead 
      to overtreatment. (c) RSNA, 2021 Online supplemental material is available for this 
      article.
FAU - Endler, Christoph H
AU  - Endler CH
AUID- ORCID: 0000-0002-5571-5527
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Ginzburg, Daniel
AU  - Ginzburg D
AUID- ORCID: 0000-0002-6727-8678
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Isaak, Alexander
AU  - Isaak A
AUID- ORCID: 0000-0003-2016-6166
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Faron, Anton
AU  - Faron A
AUID- ORCID: 0000-0002-5771-7235
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Mesropyan, Narine
AU  - Mesropyan N
AUID- ORCID: 0000-0002-5871-3965
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Kuetting, Daniel
AU  - Kuetting D
AUID- ORCID: 0000-0001-6520-1020
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Pieper, Claus C
AU  - Pieper CC
AUID- ORCID: 0000-0002-0893-1200
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Kupczyk, Patrick A
AU  - Kupczyk PA
AUID- ORCID: 0000-0001-9556-085X
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Attenberger, Ulrike I
AU  - Attenberger UI
AUID- ORCID: 0000-0002-8123-5447
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
FAU - Luetkens, Julian A
AU  - Luetkens JA
AUID- ORCID: 0000-0002-7715-4636
AD  - From the Department of Diagnostic and Interventional Radiology, University 
      Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.H.E., D.G., A.I., A.F., 
      N.M., D.K., C.C.P., P.A.K., U.I.A., J.A.L.); and Quantitative Imaging Laboratory 
      Bonn (QILaB), Bonn, Germany (C.H.E., A.I., A.F., N.M., D.K., P.A.K., J.A.L.).
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210629
PL  - United States
TA  - Radiology
JT  - Radiology
JID - 0401260
SB  - IM
MH  - Adult
MH  - Cervical Vertebrae/*injuries
MH  - Diagnosis, Differential
MH  - Female
MH  - Humans
MH  - Ligaments, Articular/*injuries
MH  - Magnetic Resonance Imaging/*methods
MH  - Male
MH  - Retrospective Studies
MH  - Spinal Injuries/*diagnostic imaging
MH  - Tomography, X-Ray Computed/*methods
MH  - Wounds, Nonpenetrating/*diagnostic imaging
EDAT- 2021/06/30 06:00
MHDA- 2021/10/12 06:00
CRDT- 2021/06/29 12:11
PHST- 2021/06/30 06:00 [pubmed]
PHST- 2021/10/12 06:00 [medline]
PHST- 2021/06/29 12:11 [entrez]
AID - 10.1148/radiol.2021204187 [doi]
PST - ppublish
SO  - Radiology. 2021 Sep;300(3):633-640. doi: 10.1148/radiol.2021204187. Epub 2021 Jun 
      29.