likely to occur than carotid injury, most commonly between
C2 and the skull base. 22, 25, 26 CT Angiography (CTA) is the
preferred method for screening of vascular injuries and is
often integrated into a whole body CT protocol for polytrauma
patients. Arterial injuries can manifest as luminal stenosis,
wall irregularity, intimal flap, pseudoaneurysm or occlusion
(Figure 7). MRI shows intramural hematoma associated with
dissection as hyperintense rim on T1 fat suppressed image.
The recognition of vascular injury is important as the presence of a dissection presents a risk of thrombus formation and
subsequent embolization. For this reason, these patients will
often be treated with anticoagulant or antiplatelet therapy. 23, 26
Imaging has become an integral part of the assessment of
traumatic spine to evaluate the site and extent of injury, spine
stability and neural element compromise. Understanding
the imaging concepts for spine trauma is important for all
practicing spine physicians. Collaborative studies and implementation of spine trauma classifications are essential in the
communication between ED physicians, radiologists, spine
surgeons and other clinical providers in order to achieve the
best outcome for our patients.
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Figure 7. (A) Sagittal CT image shows a mildly displaced
intra-articular fracture of the left superior articular process
of C4 vertebra. (B) Axial CTA and (C) Coronal MIP CTA
images show absent left vertebral artery secondary to acute
arterial dissection (arrow). There is normal enhancement
of the right vertebral artery (dashed arrow).