Accuracy of Cervical Spine CT for Detection of Craniocervical Junction Ligamentous Injury in Children.

Authors

Stephen F Kralik, Yasmin Akbari, Thierry A G M Huisman, Nilesh K Desai

Published in

AJNR. American journal of neuroradiology. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

The purpose of this study is to evaluate the diagnostic accuracy of cervical spine CT for detection of ligamentous injury of the craniocervical junction (CCJ) in children.
A retrospective review of pediatric (age < 21 years) trauma patients who underwent cervical spine CT and cervical spine MRI at time of injury was performed. CCJ measurements from the cervical spine CTs included the basion-dens interval (BDI)/basion-cartilaginous dens interval (BCDI), anterior atlantodental interval (ADI), condyle-C1 interval (CCI), C1-C2 lateral mass interval (LMI), lateral atlantodental interval (LADI), posterior atlantoaxial distance (PAAD), and prevertebral soft tissue thickness (PVSTT) at C2. Thresholds for normal and abnormal CT measurements were based on published normative pediatric cervical spine CT measurements. Presence versus absence of CCJ hemorrhage, and fracture(s) of the bones of the CCJ were also recorded. Diagnostic accuracy of CT measurements, fractures and hemorrhage for detection of ligamentous injury was calculated using cervical spine MRI diagnosis of ligamentous injury as the gold standard.
A total of 193 pediatric patients with average age 13.2 years were included. Motor vehicle accidents and falls were the most common cause of injury. A total of 55 patients (28%) had CCJ ligamentous injury on MRI. The posterior atlantoaxial ligament was the most commonly injured ligament. The incidences of CCJ fractures and hemorrhage were 10.9%, and 9.3%. Individual CCJ measurements, fractures and hemorrhage demonstrated low sensitivity and high specificity for ligamentous injury, however, the combination of one or more abnormal CT finding resulted in a high diagnostic accuracy (AUC=0.86-0.91) with sensitivity or 84-96% and specificity of 78-95% depending on the combination of CT findings used.
The combination of one or more CCJ measurements, fracture, and hemorrhage results in a very good to excellent level of diagnostic accuracy for detection of traumatic ligamentous injury at the CCJ in pediatric patients.

PMID:
42580862
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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