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Susan R. Durham, Kenneth C. Liu, and Nathan R. Selden

paralyzed, precluding a meaningful neurological examination. 1 In addition, the neurological examination in pediatric patients can be limited by age and language ability. As a result, management of severe pediatric traumatic brain injury depends on intracranial imaging findings. Computed tomography scanning allows neurosurgeons to quickly and noninvasively identify traumatic intracranial lesions. In many trauma centers around the world, CT imaging used during the initial examination of patients with suspected head injury is now the standard of care. 1 Delayed

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Alexander C. Mamourian, Daniel J. Pluta, Clifford J. Eskey, and Anthony L. Merlis

715 mA. Discussion Computed tomography angiography has gone though a quiet revolution in the past 10 years. The arrival of multi-slice CT scanners has allowed faster and more detailed CT angiography data than was possible with single-slice scanners. The rows of detectors have incrementally increased in number, and the detectors have become thinner and tube rotation times faster. The improvements in the overall quality of CT angiography have not gone unrecognized, and most programs are now seeing fewer requests for DS angiography. Whereas DS angiography is

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Matthew McDonald, Robert Cooper, and Michael Y. Wang

✓Facet disease is believed to play a major role in axial low-back pain and may prove in the future to be an important indication for posterior dynamic stabilization. However, the lack of good diagnostic tests and imaging methods for identifying this condition have made this entity obscure. Although single-photon emission computed tomography (SPECT) imaging is a highly sensitive and specific test, the images frequently lack adequate resolution, whereas computed tomography (CT) provides excellent resolution but lacks specificity.

Thirty-seven patients with back pain clinically attributable to facet disease underwent CT–SPECT fusion imaging of the lumbar spine. The SPECT images were obtained using a dual-head gamma camera equipped with VXGP high-resolution collimators using a 20% energy window centered at 140 keV and a 360° rotation totaling 128 projections at 16 seconds each. Transaxial CT images were transferred in the Digital Imaging and Communications in Medicine format to provide proper image overlay in the axial, sagittal, and coronal planes. Scanning for both modalities was performed using standard patient positioning. Patients with concordant images and symptoms then underwent joint injection and/or rhizotomy, which was performed by an independent physician.

Image fusion was successfully performed in all patients, and the image quality allowed definitive localization of the “hot” lesion in all cases, in contrast to conventional high-resolution SPECT scanning, which often led to problems differentiating L4/5 and L5/S1. In patients with solitary lesions, injection led to definitive pain resolution, even if temporary, in all cases with anesthetic blockade.

The CT–SPECT scanning modality combines the virtues of functional and anatomical imaging, aiding the clinician in making the diagnosis of painful facet arthropathy. This modality may prove useful for the selection of patients who are candidates for posterior dynamic stabilization.

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Javad Towfighi, Larissa T. Bilaniuk, Robert A. Zimmerman, Thomas W. Langfitt, and Nicholas K. Gonatas

✓ The authors present a case in which bilateral posttraumatic hemorrhages in choroid plexus hemangiomas were demonstrated by computed tomography and histopathological study.

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Harvey S. Levin, Gerri Hanten, Garland Roberson, Xiaoqi Li, Linda Ewing-Cobbs, Maureen Dennis, Sandra Chapman, Jeffrey E. Max, Jill Hunter, Russell Schachar, Thomas G. Luerssen, and Paul Swank

is related to reduced functioning in several cognitive domains during the following 12 months. Computed tomography performed within 24 hours after MTBI may be useful in identifying children with elevated risks for persistent cognitive deficits who could benefit from rehabilitation therapy and accommodation at school to facilitate recovery. Acknowledgments We are indebted to Carmen Vasquez for assistance in data collection and Stacey Martin for manuscript preparation. References 1 Alderson RM , Rapport MD , Kofler MJ : Attention

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Mirza N. Baig, Ali Raza, Moumen Asbahi, and Scott Elton

M agnetic resonance imaging is the preferred neuroimaging modality for the diagnosis of CM-I. 5 Sagittal views are especially useful in measuring the tonsillar displacement with respect to the foramen magnum. 1 , 3 , 5 Computed tomography scanning of the head, however, is performed far more frequently in children than MR imaging for a multitude of reasons. As part of the workup, radiologists routinely comment on the position of the cerebellar tonsils in relation to the foramen magnum. Based on suspicious CT findings, the radiologist may recommend further

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Da Zou, Aikeremujiang Muheremu, Zhuoran Sun, Woquan Zhong, Shuai Jiang, and Weishi Li

of all authors: Li. Statistical analysis: Zou, Muheremu. Administrative/technical/material support: Li, Sun, Zhong, Jiang. Study supervision: Li. References 1 Abul-Kasim K , Ohlin A : Evaluation of implant loosening following segmental pedicle screw fixation in adolescent idiopathic scoliosis: a 2 year follow-up with low-dose CT . Scoliosis 9 : 13 , 2014 2 Anderson PA , Polly DW , Binkley NC , Pickhardt PJ : Clinical use of opportunistic computed tomography screening for osteoporosis . J Bone Joint Surg Am 100 : 2073 – 2081 , 2018 3 Bredow

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Korak Sarkar, Krista Keachie, UyenThao Nguyen, J. Paul Muizelaar, Marike Zwienenberg-Lee, and Kiarash Shahlaie

Admission CT scans play a critical role in the acute management of both adult and pediatric TBI. Computed tomography findings are used to classify injury patterns, predict survival and functional outcome, and guide surgical and neurocritical care interventions. Previous studies have shown that the biomechanics of TBI are significantly different between children and adults, 13 , 23 as are the anatomical relationships between the brain and its surrounding supportive structures. 7 , 29 Despite these differences, however, it is not known if CT findings after TBI

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Jayme Augusto Bertelli and Marcos Flávio Ghizoni

described. Computed Tomography Myelography Computed tomography myelography was performed 2 days before surgery by one of the authors. Axial 2-mm-thick sections were obtained in the cervical region. Root preservation was considered probable if the root imprint was visualized. The contralateral, uninvolved side was used for comparison. Surgical Procedure After general anesthesia had been induced and the patient had been placed in the supine position, the brachial plexus was explored through a vertical incision 1 cm anterior to the sternocleidomastoid muscle

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Paul Klimo Jr. and Richard H. Schmidt

✓The elucidation of predictive factors of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a major area of both clinical and basic science research. It is becoming clear that many factors contribute to this phenomenon. The most consistent predictor of vasospasm has been the amount of SAH seen on the postictal computed tomography scan. Over the last 30 years, it has become clear that the greater the amount of blood within the basal cisterns, the greater the risk of vasospasm. To evaluate this risk, various grading schemes have been proposed, from simple to elaborate, the most widely known being the Fisher scale. Most recently, volumetric quantification and clearance models have provided the most detailed analysis. Intraventricular hemorrhage, although not supported as strongly as cisternal SAH, has also been shown to be a risk factor for vasospasm.