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Special Radiology

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Abstract

The anatomy and pathology of the craniovertebral junction (CVJ) may be complex but can be readily visualized by a variety of radiological means. The primary modalities include simple plain radiographs, computer tomography (CT), and magnetic resonance imaging (MRI). Each clinical scenario warrants a different imaging modality or, more commonly, a combination of multiple modalities. This chapter describes these imaging modalities as they pertain to the CVJ. Specific pathologies are discussed in separate chapters.

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References

  1. Abe, H., Tsuru, M., Mitsumori, K.: Atlanto-axial dislocation–instability index and indications for surgery (author’s transl). No Shinkei Geka 4, 57–72 (1976)

    CAS  PubMed  Google Scholar 

  2. Bono, C.M., Vaccaro, A.R., Fehlings, M., et al.: Measurement techniques for upper cervical spine injuries: consensus statement of the Spine Trauma Study Group. Spine (Phila Pa 1976) 32, 593–600 (2007)

    Google Scholar 

  3. Boudin, G., Fischgold, H., Pepin, B., et al.: Syringomyelitic syndrome and associated complex malformations, especially of the atlanto-occipital joint and of the cervical vertebrae. Rev Neurol (Paris) 87, 347–352 (1952)

    CAS  Google Scholar 

  4. Brenner, D., Elliston, C., Hall, E., et al.: Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176, 289–296 (2001)

    CAS  PubMed  Google Scholar 

  5. Bundschuh, C., Modic, M.T., Kearney, F., et al.: Rheumatoid arthritis of the cervical spine: surface-coil MR imaging. AJR Am J Roentgenol 151, 181–187 (1988)

    CAS  PubMed  Google Scholar 

  6. Chamberlain, W.E.: Basilar impression (platybasia): A bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med 11, 487–496 (1939)

    Google Scholar 

  7. Clark, C.R., Goetz, D.D., Menezes, A.H.: Arthrodesis of the cervical spine in rheumatoid arthritis. J Bone Joint Surg Am 71, 381–392 (1989)

    CAS  PubMed  Google Scholar 

  8. Deliganis, A.V., Mann, F.A., Grady, M.S.: Rapid diagnosis and treatment of a traumatic atlantooccipital dissociation. AJR Am J Roentgenol 171, 986 (1998)

    CAS  PubMed  Google Scholar 

  9. Dickman, C.A., Greene, K.A., Sonntag, V.K.: Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery 38, 44–50 (1996)

    Article  CAS  PubMed  Google Scholar 

  10. Dolan, K.D.: Cervicobasilar relationships. Radiol Clin North Am 15, 155–166 (1977)

    CAS  PubMed  Google Scholar 

  11. Dumas, J.L., Salama, J., Dreyfus, P., et al.: Magnetic resonance angiographic analysis of atlanto-axial rotation: anatomic bases of compression of the vertebral arteries. Surg Radiol Anat 18, 303–313 (1996)

    Article  CAS  PubMed  Google Scholar 

  12. Epstein, N.E., Hyman, R.A., Epstein, J.A., et al.: “Dynamic” MRI scanning of the cervical spine. Spine (Phila Pa 1976) 13, 937–938 (1988)

    CAS  Google Scholar 

  13. Gilbert, J.W., Wheeler, G.R., Lingreen, R.A., et al.: Open stand-up MRI: a new instrument for positional neuroimaging. J Spinal Disord Tech 19, 151–154 (2006)

    Article  PubMed  Google Scholar 

  14. Goel, A., Shah, A., Rajan, S.: Vertical mobile and reducible atlantoaxial dislocation. Clinical article. J Neurosurg Spine 11, 9–14 (2009)

    Article  PubMed  Google Scholar 

  15. Gupta, V., Khandelwal, N., Mathuria, S.N., et al.: Dynamic magnetic resonance imaging evaluation of CVJ abnormalities. J Comput Assist Tomogr 31, 354–359 (2007)

    Article  PubMed  Google Scholar 

  16. Guyot, L., Richard, O., Adalian, P., et al.: An anthropometric study of relationships between the clival angle and craniofacial measurements in adult human skulls. Surg Radiol Anat 28, 559–563 (2006)

    Article  CAS  PubMed  Google Scholar 

  17. Harris Jr., J.H., Carson, G.C., Wagner, L.K.: Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 162, 881–886 (1994)

    PubMed  Google Scholar 

  18. Harris Jr., J.H., Carson, G.C., Wagner, L.K., et al.: Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 162, 887–892 (1994)

    PubMed  Google Scholar 

  19. Heller, J.G., Viroslav, S., Hudson, T.: Jefferson fractures: the role of magnification artifact in assessing transverse ligament integrity. J Spinal Disord 6, 392–396 (1993)

    Article  CAS  PubMed  Google Scholar 

  20. Hinck, V.C., Hopkins, C.E.: Measurement of the atlanto-dental interval in the adult. Am J Roentgenol Radium Ther Nucl Med 84, 945–951 (1960)

    CAS  PubMed  Google Scholar 

  21. Janeway, R., Toole, J.F., Leinbach, L.B., et al.: Vertebral artery obstruction with basilar impression. An intermittent phenomenon related to head turning. Arch Neurol 15, 211–214 (1966)

    CAS  PubMed  Google Scholar 

  22. Karhu, J.O., Parkkola, R.K., Koskinen, S.K.: Evaluation of flexion/extension of the upper cervical spine in patients with rheumatoid arthritis: an MRI study with a dedicated positioning device compared to conventional radiographs. Acta Radiol 46, 55–66 (2005)

    Article  CAS  PubMed  Google Scholar 

  23. Kevles, B.: Body imaging. How doctors learned to peer beneath our skin to see what might be wrong without using surgery. Newsweek 130, 74–76 (1997)

    PubMed  Google Scholar 

  24. Klaus, E.: Roentgen diagnosis of platybasia & basilar impression; additional experience with a new method of examination. Fortschr Geb Rontgenstr Nuklearmed 86, 460–469 (1957)

    Article  CAS  PubMed  Google Scholar 

  25. Krodel, A., Refior, H.J., Westermann, S.: The importance of functional magnetic resonance imaging (MRI) in the planning of stabilizing operations on the cervical spine in rheumatoid patients. Arch Orthop Trauma Surg 109, 30–33 (1990)

    Article  CAS  PubMed  Google Scholar 

  26. Kulkarni, A.G., Goel, A.H.: Vertical atlantoaxial index: a new craniovertebral radiographic index. J Spinal Disord Tech 21, 4–10 (2008)

    Article  PubMed  Google Scholar 

  27. Lee, C., Woodring, J.H., Goldstein, S.J., et al.: Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol 8, 19–26 (1987)

    CAS  PubMed  Google Scholar 

  28. McGregor, M.: The significance of certain measurements of the skull in the diagnosis of basilar impression. Br J Radiol 21, 171–181 (1948)

    Article  Google Scholar 

  29. McRae, D.L., Barnum, A.S.: Occipitalization of the atlas. AJR Am J Roentgenol 70, 23 (1953)

    CAS  Google Scholar 

  30. Metzger, J., Fischgold, H., Appel, L.: Special radiographical examinations in fractures of the base of the skull. Ann Med Leg Criminol Police Sci Toxicol 42, 5–12 (1962)

    CAS  PubMed  Google Scholar 

  31. Monu, J., Bohrer, S.P., Howard, G.: Some upper cervical spine norms. Spine (Phila Pa 1976) 12, 515–519 (1987)

    CAS  Google Scholar 

  32. Oliva, L.: Alessandro Vallebona (1899–1987). Radiol Med 76, 127129 (1988)

    Google Scholar 

  33. Pang, D.: Atlantoaxial rotatory fixation. Neurosurgery 66, A161–A183 (2010)

    Article  Google Scholar 

  34. Pang, D., Nemzek, W.R., Zovickian, J.: Atlanto-occipital dislocation: part 1 – normal occipital condyle-C1 interval in 89 children. Neurosurgery 61, 514–521 (2007). discussion 521

    Article  PubMed  Google Scholar 

  35. Powers, B., Miller, M.D., Kramer, R.S., et al.: Traumatic anterior atlanto-occipital dislocation. Neurosurgery 4, 12–17 (1979)

    Article  CAS  PubMed  Google Scholar 

  36. Raju, T.N.: The Nobel chronicles. 1979: Allan MacLeod Cormack (b 1924); and Sir Godfrey Newbold Hounsfield (b 1919). Lancet 354, 1653 (1999)

    Article  CAS  PubMed  Google Scholar 

  37. Ranawat, C.S., O’Leary, P., Pellicci, P., et al.: Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am 61, 1003–1010 (1979)

    CAS  PubMed  Google Scholar 

  38. Redlund-Johnell, I., Pettersson, H.: Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol Diagn (Stockh) 25, 23–28 (1984)

    CAS  Google Scholar 

  39. Reijnierse, M., Bloem, J.L., Dijkmans, B.A., et al.: The cervical spine in rheumatoid arthritis: relationship between neurologic signs and morphology of MR imaging and radiographs. Skeletal Radiol 25, 113–118 (1996)

    Article  CAS  PubMed  Google Scholar 

  40. Riederer, S.J.: MR imaging: its development and the recent Nobel Prize. Radiology 231, 628–631 (2004)

    Article  PubMed  Google Scholar 

  41. Riew, K.D., Hilibrand, A.S., Palumbo, M.A., et al.: Diagnosing basilar invagination in the rheumatoid patient. The reliability of radiographic criteria. J Bone Joint Surg Am 83-A, 194–200 (2001)

    CAS  Google Scholar 

  42. Rojas, C.A., Bertozzi, J.C., Martinez, C.R., et al.: Reassessment of the craniocervical junction: normal values on CT. AJNR Am J Neuroradiol 28, 1819–1823 (2007)

    Article  CAS  PubMed  Google Scholar 

  43. Sassard, R., O’Leary, J.P.: Egas Moniz: pioneer of cerebral angiography. Am Surg 64, 1116–1117 (1998)

    CAS  PubMed  Google Scholar 

  44. Scher, A., Vambeck, V.: An approach to the radiological examination of the cervico-dorsal junction following injury. Clin Radiol 28, 243–246 (1977)

    Article  CAS  PubMed  Google Scholar 

  45. Smoker, W.R.: CVJ: normal anatomy, craniometry, and congenital anomalies. Radiographics 14, 255–277 (1994)

    CAS  PubMed  Google Scholar 

  46. Spence Jr., K.F., Decker, S., Sell, K.W.: Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am 52, 543–549 (1970)

    PubMed  Google Scholar 

  47. Suzuki, F., Fukami, T., Tsuji, A., et al.: Discrepancies of MRI findings between recumbent and upright positions in atlantoaxial lesion. Report of two cases. Eur Spine J 17(Suppl 2), S304–S307 (2008)

    Article  PubMed  Google Scholar 

  48. Tassanawipas, A., Mokkhavesa, S., Chatchavong, S., et al.: Magnetic resonance imaging study of the craniocervical junction. J Orthop Surg (Hong Kong) 13, 228–231 (2005)

    CAS  Google Scholar 

  49. Tominaga, T., Takahashi, T., Shimizu, H., et al.: Rotational vertebral artery occlusion from occipital bone anomaly: a rare cause of embolic stroke. Case report. J Neurosurg 97, 1456–1459 (2002)

    Article  PubMed  Google Scholar 

  50. van Gilder, J.C., Menezes, A.H., Dolan, K.A.: Radiology of the CVJ and its abnormalities, pp. 29–68. Futura Mount Kisco, New York (1987)

    Google Scholar 

  51. Vates, G.E., Wang, K.C., Bonovich, D., et al.: Bow hunter stroke caused by cervical disc herniation. Case report. J Neurosurg 96, 90–93 (2002)

    Article  PubMed  Google Scholar 

  52. Wackenheim, A.: Radiologic diagnosis of congenital forms, intermittent forms and progressive forms of stenosis of the spinal canal at the level of the atlas. Acta Radiol Diagn (Stockh) 9, 759–768 (1969)

    CAS  Google Scholar 

  53. Wang, C., Wang, S.: Letter to the Editor concerning “The single transoral approach for Os odontoideum with irreducible atlantoaxial dislocation” by Wang X, Fan CY, Liu ZH, Eur Spine J. 2009 Jul 14. Eur Spine J 19, 502–504 (2009). author reply 505–507

    Article  PubMed  Google Scholar 

  54. Wang, C., Yan, M., Zhou, H.T., et al.: Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine (Phila Pa 1976) 31, E306–313 (2006)

    Google Scholar 

  55. Watanabe, I.S., Madeira, M.C., Watanabe, I.S., et al.: The clivus-sphenoidale angle in children (postnatal flexion of the cranial base). Rev Bras Pesqui Med Biol 10, 325–329 (1977)

    CAS  PubMed  Google Scholar 

  56. Watanabe, M., Toyama, Y., Fujimura, Y.: Atlantoaxial instability in os odontoideum with myelopathy. Spine (Phila Pa 1976) 21, 1435–1439 (1996)

    CAS  Google Scholar 

  57. Wholey, M.H., Bruwer, A.J., Baker Jr., H.L.: The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 71, 350–356 (1958)

    CAS  PubMed  Google Scholar 

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Choutka, O., Suchomel, P. (2011). Special Radiology. In: Reconstruction of Upper Cervical Spine and Craniovertebral Junction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-13158-5_3

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  • DOI: https://doi.org/10.1007/978-3-642-13158-5_3

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