, Volume 52, Issue 3, pp 215–223 | Cite as

MRI of the transverse and alar ligaments in rheumatoid arthritis: feasibility and relations to atlantoaxial subluxation and disease activity

  • Nils VettiEmail author
  • Rikke Alsing
  • Jostein Kråkenes
  • Jarle Rørvik
  • Nils Erik Gilhus
  • Johan Gorgas Brun
  • Ansgar Espeland
Diagnostic Neuroradiology



Dysfunctional transverse and alar craniovertebral ligaments can cause instability and osseous destruction in rheumatoid arthritis (RA). This study examined (1) the feasibility of high-resolution magnetic resonance imaging (MRI) of these ligaments in RA and (2) the relation between ligament high-signal changes and atlantoaxial subluxation and RA duration/severity.


Consecutive RA patients (n = 46) underwent clinical examination, functional radiography, and high-resolution MRI. Two blinded radiologists rated MRI image quality, graded ligament high-signal changes 0–3 on proton-weighted sequences using an existing grading system, and assessed cervical spine rheumatic changes on short tau inversion recovery images. Agreement was analyzed using kappa and relations using multiple logistic regression.


MRI images had good quality in 42 (91.3%) of 46 patients and were interpretable in 44 (32 women and 12 men, median age/disease duration 60.4/9.1 years). MRI grades 2–3 changes of the transverse and alar ligaments showed moderate and good interobserver agreement (kappa 0.59 and 0.78), respectively, and prevalence 31.8% and 34.1%. Such ligament changes were more frequent with increasing anterior atlantoaxial subluxation (p = 0.012 transverse, p = 0.028 alar), higher erythrocyte sedimentation rate (p = 0.003 transverse), positive rheumatoid factor (p = 0.002 alar), and neck pain (p = 0.004 alar).


This first study of high-resolution MRI of these ligaments in RA showed high feasibility and relations with atlantoaxial subluxation, RA disease activity, and neck pain. The clinical usefulness of such MRI needs further evaluation.


Alar ligament Transverse ligament Rheumatoid arthritis Magnetic resonance imaging Radiography 



GE Eide, Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway supervised the statistical analysis. The study received funding from Grieg Foundation and the Norwegian Foundation for Health and Rehabilitation.

Conflict of interest statement

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Nils Vetti
    • 1
    • 2
    Email author
  • Rikke Alsing
    • 3
    • 4
  • Jostein Kråkenes
    • 1
    • 2
  • Jarle Rørvik
    • 1
    • 2
  • Nils Erik Gilhus
    • 5
    • 6
  • Johan Gorgas Brun
    • 3
    • 4
  • Ansgar Espeland
    • 1
    • 2
  1. 1.Department of RadiologyHaukeland University HospitalBergenNorway
  2. 2.Section for Radiology, Department of Surgical SciencesUniversity of BergenBergenNorway
  3. 3.Department of RheumatologyHaukeland University HospitalBergenNorway
  4. 4.Section for Rheumatology, Institute of MedicineUniversity of BergenBergenNorway
  5. 5.Department of NeurologyHaukeland University HospitalBergenNorway
  6. 6.Section for Neurology, Department of Clinical MedicineUniversity of BergenBergenNorway

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