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Multislice CT in imaging of trauma of the spine, pelvis and complex foot injuries

Department of Accident and Orthopaedic X-ray, Frenchay Hospital, Beckspool Road, Frenchay, Bristol B16 1JE, UK

View larger version (123K): [in a new window]   Figure 1. (a) Plain lateral radiograph of the cervical spine. Only five vertebral bodies are visualized. (b) Sagittal image showing fracture avulsion of the posterior inferior corner of C6. (c) Sagittal CT scan on the same patient showing unilateral perched facet (left) C6 on C7. (d) Coronal image, same patient, showing fracture of the lateral mass of C7.

View larger version (240K): [in a new window]   Figure 2. (a) Sagittal plain radiograph of the cervical spine. There is an acute kyphotic angulation at C6/7 and a fracture of C7 with anterior wedging due to collapse of the superior endplate. There is a separated bone fragment from the superior endplate of C7. The C6/7 disc space is widened posteriorly. No other fractures were demonstrated on plain film. (b) Sagittal multislice CT (MSCT) showing fractures demonstrated on the plain radiograph, but in addition there is a retropulsed fragment of the posterior superior part of C7 into the canal. (c) Axial MSCT image of the fractured C7 vertebra showing the retropulsed fragment posteriorly displaced into the canal. (d) Sagittal MSCT image showing fracture of the inferior facet of C6. This was not diagnosed on the plain film. (e) Coronal MSCT showing fractures of the uncovertebral processes of C7. (f) Coronal MSCT image showing additional burst fracture at C6 not demonstrated on the plain radiograph.

View larger version (218K): [in a new window]   Figure 3. (a) Lateral plain radiograph of the upper cervical spine in a rheumatoid patient following trauma. A fracture of the posteriorring of C1 is clearly demonstrated. There is also a possible fracture across the base of the dens but this area is not as well visualized. (b) Open mouth view of the dens. There is suspicion of a fracture through the base of the dens. (c) Sagittal multislice CT (MSCT) image confirms an undisplaced type II dens fracture. (d) Coronal MSCT scan of the dens clearly demonstrating type II fracture through the base of the dens. (e) A fracture through the anterior part of the C1 ring is demonstrated on the axial MSCT image. This was not demonstrated on any of the plain radiographs.

View larger version (96K): [in a new window]   Figure 4. (a) Plain lateral radiograph of the cervical spine showing marked prominence of the pre-vertebral soft tissues following trauma. Pre-vertebral haemorrghage is suspected. There are degenerative changes at C5/6 with narrowing of the disc space and sclerosis at the endplates. (b) Sagittal multislice CT showing osteophytes at C6/7 and disc space narrowing consistent with degenerative changes. No fracture is identified and the pre-vertebral soft tissues are not adequately visualized. (c) A sagittal T2 weighted MR image with fat suppression showing bright signal within the pre-vertebral soft tissues with central areas of low signal. Bright signal is also present posteriorly and between the spinous processes. The appearances are consistent with haemorrghage and oedema due to soft tissue and ligament injury (anteriorly and posteriorly). There is linear signal across the C5 vertebral body in keeping with marrow haemorrghage or a fracture.

View larger version (251K): [in a new window]   Figure 5. (a) Plain radiograph (anteroposterior film) showing reduced height of L3 following fracture and widening of the right L2/3 facet joint space. (b) Plain radiograph (lateral) demonstrating fracture of L3. There is collapse of the superior endplate of the vertebral body with anterior wedging. (c) Sagittal multislice CT (MSCT) showing burst fracture of L3 with multiple fragments anteriorly and posteriorly and a fracture of the lamina of L3 not identified on the plain film. (d) Coronal MSCT demonstrates burst fracture of L3 but also fracture of the inferior right corner of L2. The L2 vertebral body is laterally translocated and rotated anticlockwise relative to L3. (e) Coronal MSCT showing disrupted right L2/3 facet joint and fracture of the left lamina of L3 as a result of fracture/rotation of L2 on L3. (f) Three-dimensional MSCT clearly demonstrating fracture of the inferior endplate of L2 and burst fracture of L3. (g) Sagittal T2 weighted MRI showing compression of the cauda equina nerve roots by the retropulsed posterior superior fracture fragment of L3. (h) Sagittal T2 weighted MR image showing severe narrowing of the spinal canal by the retropulsed posterior superior fracture fragment of L3.

View larger version (150K): [in a new window]   Figure 6. (a) Normal sagittal thick slice multiplanar reconstruction (MPR) of the thoracolumbar spine mimicking lateral plain radiograph. (b) Coronal thick slice MPR of the thoracolumbar spine mimicking anteroposterior radiograph.

View larger version (220K): [in a new window]   Figure 7. (a) Oblique plain radiograph showing posterior column fracture of the acetabulum with a large separated fragment. (b) Sagittal multislice CT (MSCT) reconstruction of the acetabulum showing the separated posterior column fragment. (c) Axial MSCT showing acetabular fractures. (d) Radiolucent three-dimensional (3D) image of the pelvis in the sagittal plane showing fracture of the posterior column with a large separated fragment. (e) 3D image of the pelvis showing posterior column fracture.

View larger version (93K): [in a new window]   Figure 8. (a) "Judet view" transluscent three-dimensional (3D) image of the pelvis demonstrating bilateral sacral fractures, fractures of the right acetabulum posterior wall and fracture of the left pubic rami. (b) 3D image of the pelvis showing bilateral sacral fractures, bilateral pubic rami fractures and fracture of the right transverse process of L5. (c) Pelvic inlet 3D reconstruction to demonstrate the pelvic ring and to assess displacement of the fractured left hemipelvis.

View larger version (142K): [in a new window]   Figure 9. (a) Coronal multiplanar reconstruction (MPR) demonstrating comminuted fracture of the calcaneum and the main fracture fragments (sustentaculum, body and lateral fragment. (b) Axial MPR of comminuted calcaneal fracture demonstrating three main fracture fragments. (c) Sagittal MPR of comminuted calcaneal fracture.

View larger version (142K): [in a new window]   Figure 10. (a) Plain radiograph showing Lisfranc fracture. There is malalignment between the second metatarsal and the middle cuneiform indicating a dislocation at the tarsometatarsal joint. (b) Axial multislice CT showing Lisfranc fracture. Malalignment of the second tarsometatarsal joint is identified. There is associated avulsion fracture of the adjacent first cuneiform.