Combining CT Signs Yields High Accuracy for Pediatric Craniocervical Ligament Injury

Combining abnormal craniocervical junction (CCJ) CT measurements, fracture, and hemorrhage yields high diagnostic accuracy (AUC 0.86-0.91) for pediatric CCJ ligamentous injury, with sensitivity up to 96% and specificity 95%.

• Individual CT measurements, fracture, or hemorrhage alone had low sensitivity but high specificity for ligamentous injury.
• Posterior atlantoaxial ligament was the most commonly injured ligament (193 children; 28% had MRI-confirmed injury).
• Retrospective study using MRI as the reference standard; CT thresholds were based on published normative pediatric data.

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