Prevertebral soft tissue

Abnormally increased prevertebral soft tissue (PVST) may indicate the presence of a cervical spine fracture, cervical dislocation, or ligamentous disruption.

Plain films are subject to errors due to magnification and rotation. Multi-detector CT (MDCT) eliminates these shortcomings.

Increased PVST is more likely with anterior than posterior injuries.

NB: the sensitivity of these measurements is only ≈ 60% at C3 and 5% at C6.

False positives may occur with basal skull/facial fractures, especially with fracture of the pterygoid plates. An ET-tube may allow fluid to accumulate in the posterior oropharynx which can obscure this measurement. In this setting, one can look for a thin fat layer between the prevertebral muscles and the posterior pharynx on cervical CT.

The prevertebral tissue (posterior to this line) will be thickened (no measurements available at this time). MRI can also demonstrate abnormal signal within the prevertebral tissue.