Acil Nörolojik Hastalıklarda Spinal Görüntüleme İlkeleri
Özet
Spinal aciller kalıcı işlev bozukluklarına yol açabilmesi ve yüksek mortalite nedeniyle erken tanı ve tedavi gerektirirler. Yanlış tanı ve gecikmiş tedavi kalıcı nörolojik sekellere ve mortaliteye sebep olabilir. Bu nedenle görüntüleme yöntemleri nörolojik acil durumların hepsinde olduğu gibi spinal acillerde de son derece önemli bir yere sahiptir.
Yüksek enerjili travmalarda direk grafi(DG) ile zaman kaybedilmeden Bilgisayarlı tomografi(BT) çeilmelidir. Thorax ve abdominal BT üzerinden de spinal kanal değerlendirilebilir ancak şüpheli durumlarda risk alınamamalı ve tüm spinal BT ayrıca yeniden çekilmelidir. Nörolojik sekel varlığında BT normal izlense de Manyetik Rezonans Görüntüleme(MR) de mutlaka çekilmelidir. MR ayrıca travma dışı spinal acillerde de herzaman ana görüntüleme yöntemi olmalıdır.
Referanslar
Arce D, Sass P, Abul-Khoudoud H. Recognizing spinal cord emergencies [published correction appears in Am Fam Physician 2002 May 1;65(9):1751]. Am Fam Physician. 2001;64(4):631-638.
Saltzherr TP, Fung Kon Jin PH, Beenen LF, Vandertop WP, Goslings JC. Diagnostic imaging of cervical spine injuries following blunt trauma: a review of the literature and practical guideline. Injury. 2009;40(8):795-800. doi:10.1016/j.injury.2009.01.015
Looby S, Flanders A. Spine trauma. Radiol Clin North Am. 2011;49(1):129-163. doi:10.1016/j.rcl.2010.07.019
Heinemann U, Freund M. Diagnostic strategies in spinal trauma. Eur J Radiol. 2006;58(1):76-88. doi:10.1016/j.ejrad.2005.12.007
Grossman MD, Reilly PM, Gillett T, Gillett D. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers. J Trauma. 1999;47(4):684-690. doi:10.1097/00005373-199910000-00012
Davis JW, Phreaner DL, Hoyt DB, Mackersie RC. The etiology of missed cervical spine injuries. J Trauma 1993; 34: 342-6.
Poonnoose PM, Ravichandran G, McClelland MR. Missed and mismanaged injuries of the spinal cord. J Trauma. 2002;53(2):314-320. doi:10.1097/00005373-200208000-00021
Sheikh K, Belfi LM, Sharma R, Baad M, Sanelli PC. Evaluation of acute cervical spine imaging based on ACR Appropriateness Criteria(R). Emerg Radiol 2012; 19: 11-7
Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group [published correction appears in N Engl J Med 2001 Feb 8;344(6):464]. N Engl J Med. 2000;343(2):94-99. doi:10.1056/NEJM200007133430203
Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet 2001; 357: 1391-6.
Tins BJ, Cassar-Pullicino VN. Imaging of acute cervical spine injuries: review and outlook. Clin Radiol 2004; 59: 865-80.
Cassar-Pullicino VN. Spinal injury: optimising the imaging options. Eur J Radiol 2002; 42: 85-91.
Darras K, Andrews GT, McLaughlin PD, Khorrami-Arani N, Roston A, Forster BB, et al. Pearls for Interpreting Computed Tomography of the Cervical Spine in Trauma. Radiol Clin North Am 2015; 53: 657-74, vii
Dundamadappa SK, Cauley KA. MR imaging of acute cervical spinal ligamentous and soft tissue trauma. Emerg Radiol 2012; 19: 277-86
Demaerel P. Magnetic resonance imaging of spinal cord trauma: a pictorial essay. Neuroradiology 2006; 48: 223-32.
Richards PJ. Cervical spine clearance: a review. Injury 2005; 36: 248-69; discussion 70.
Vanel D, Bittoun J, Tardivon A. MRI of bone metastases. Eur Radiol 1998; 8: 1345-51.
Heldner MR, Arnold M, Nedeltchev K, Gralla J, Beck J, Fischer U. Vascular diseases of the spinal cord: A review. Curr Treat Options Neurol 2012; 14: 509-20.
Nedeltchev K, Loher TJ, Stepper F, Arnold M, Schroth G, Mattle HP, et al. Long-Term Outcome of Acute Spinal Cord Ischemia Syndrome. Stroke 2004; 35: 560-5.
Wang VY, Chou D, Chin C. Spine and spinal cord emergencies: Vascular and infectious causes. Neuroimaging Clin N Am 2010; 20: 639-50
Vanel D, Bittoun J, Tardivon A. MRI of bone metastases. Eur Radiol 1998; 8: 1345-51
