Skip to main content
SpringerLink
Log in

How does the neck flexion affect the cervical MRI features of Hirayama disease?

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Although flexion cervical MRI has been recommended for the diagnosis of Hirayama disease (HD), no study focused on the MR features at different neck flexion angles. Moreover, no uniform flexion angle has been confirmed in clinical practice. The purpose of this study is to quantitatively investigate the MRI typical signs of HD patients in different neck flexion degree and gives a suggestion to the MR scanning. Cervical MRI in neutral and different flexion positions (cervical flexion angle 20°, 25°, 30°, 35°, and 40°) were performed in 45 HD patients. Three MRI features including anterior shifting of the posterior wall of the cervical dural canal (ASD), widening of cervical epidural space, and epidural flow voids (EFV) at each flexed position were summarized. To evaluate ASD quantitatively, the widest cervical epidural space with the maximum sagittal diameters (d) and cervical canal sagittal diameter (D) at the same level were measured. The d/D values at different angles were calculated and compared. ASD was demonstrated in 34 out of 45 cases (75.6%) at 20° and in all cases (100%) at other 4 angles (χ 2 = 25.728, P < 0.05). Significant difference was demonstrated for the appearance rate of EFV (mean 72.8%) among different angles (χ 2 = 11.373, P = 0.021). The peak mean d/D value was found at 35°. Neck flexion angles have effects on ASD, widening of cervical epidural space and EFV. 25° is recommended as the least effective diagnostic flexion angle for MRI diagnosis of HD, and 35° may be the best one.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

HD:

Hirayama disease

ASD:

Anterior shifting of the posterior wall of the cervical dural canal

EFV:

Epidural flow voids

RF:

Radiofrequency

References

  1. Fu Y, Pei X, Zhang J, Kang D, Han H, Fan D (2008) Morphological changes of the lower cervical spinal cord under neutral and fully flexed position by MRI in Chinese patients with Hirayama’s disease. Amyotroph Lateral Scler 9:156–162

    Article  PubMed  Google Scholar 

  2. Robberecht W, Aguirre T, VandenBosch L et al (1997) Familial juvenile focal amyotrophy of the upper extremity (Hirayama disease)—Superoxide dismutase 1 genotype and activity. Arch Neurol Chicago 54:46–50

    Article  PubMed  CAS  Google Scholar 

  3. Schroder R, Keller E, Flacke S et al (1999) MRI findings in Hirayama’s disease: flexion-induced cervical myelopathy or intrinsic motor neuron disease? J Neurol 246:1069–1074

    Article  PubMed  CAS  Google Scholar 

  4. Hirayama K, Tokumaru Y (2000) Cervical dural sac and spinal cord in juvenile muscular atrophy of distal upper extremity. Neurology 54:1922–1926

    Article  PubMed  CAS  Google Scholar 

  5. Chen CJ, Chen CM, Wu CL, Ro LS, Chen ST, Lee TH (1998) Hirayama disease: MR diagnosis. Am J Neuroradiol 19:365–368

    PubMed  CAS  Google Scholar 

  6. Baba Y, Nakajima M, Utsunomiya H et al (2004) Magnetic resonance imaging of thoracic epidural venous dilation in Hirayama disease. Neurology 62:1426–1428

    Article  PubMed  CAS  Google Scholar 

  7. Sonwalkar HA, Shah RS, Khan FK et al (2008) Imaging features in Hirayama disease. Neurol India 56:22–26

    Article  PubMed  Google Scholar 

  8. Pei X, Han H, Xie J et al (2006) Dynamic magnetic resonance imaging study on Hirayama disease. Chin J Med Imaging Technol 26:1255–1257

    Google Scholar 

  9. Liu H, Li C, He D et al (2006) The diagnosis of a fully flexed neck position MRI diagnosis in juvenile muscular atrophy of the distal upper extremity. Chin J Radiol 40:745–747

    CAS  Google Scholar 

  10. Fu Y, Fan D, Pei X et al (2007) MRI diagnosis of Hirayama disease. Chin J Radiol 41:352–355

    Google Scholar 

  11. Hirayama K (1991) Non-progressive juvenile spinal muscular atrophy of the distal upper limb (Hirayama’s disease). In: De Jong JM (ed.) Handbook of clinical neurology. Vol 15. Elsevier, Amsterdam, pp 107–120

  12. Bossuyt PM, Reitsma JB, Bruns DE (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Radiology 226:24–28

    Article  PubMed  Google Scholar 

  13. Takeshita K, Peterson ET, Bylski-Austrow D, Crawford AH, Nakamura K (2004) The nuchal ligament restrains cervical spine flexion. Spine 29((Phila Pa 1976)):E388–E393

    Article  PubMed  Google Scholar 

  14. Patel TR, Chiocca EA, Freimer ML, Christoforidis GA (2009) Lack of epidural pressure change with neck flexion in a patient with Hirayama disease: case report. Neurosurgery 64:1196–1197

    Article  Google Scholar 

Download references

Acknowledgments

This research was founded by Program for New Century Excellent Talents in University (Grant number: NCET-05-0019), National Natural Science Foundation of China (Grant number: 30972811) and Beijing municipal commission of education.

Author information

Authors and Affiliations

  1. The Radiology Department, Peking University Third Hospital, North Huayuan Road No. 49, Haidian District, Beijing, 100191, China

    Chao Hou, Hongbin Han & Xiaojuan Xu

  2. Dalian Medical University Second Hospital, Dalian, China

    Xiaohong Yang

  3. Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, 100035, China

    Hui Gao

  4. The Neurology Department, Peking University Third Hospital, Beijing, 100191, China

    Dongsheng Fan & Yu Fu

  5. The Orthopedic Department, Peking University Third Hospital, Beijing, 100191, China

    Yu Sun

  6. Image Processing Center, Beihang University, Beijing, 100191, China

    Bo Liu

Authors
  1. Chao Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongbin Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaohong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaojuan Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hui Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dongsheng Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yu Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yu Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bo Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hongbin Han.

Additional information

C. Hou, X. Yang, X. Xu and H. Gao contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hou, C., Han, H., Yang, X. et al. How does the neck flexion affect the cervical MRI features of Hirayama disease?. Neurol Sci 33, 1101–1105 (2012). https://doi.org/10.1007/s10072-011-0912-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-011-0912-x

Keywords

Search

Navigation