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Imaging Assessment of Craniocervical Junction Instability

Author: XuLiang
Tutor: LiuZuo；ZhongJin
School: Tianjin Medical University
Course: Medical Imaging and Nuclear Medicine
Keywords: The at the junction of District, of the the cranio-cervical Pillow atlantoaxial joint Atlantoaxial joint Instability Tomography , X - ray computed Magnetic resonance imaging
CLC: R687.3
Type: Master's thesis
Year: 2008
Downloads: 23
Quote: 0
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Abstract


Objective: To summarize the pillow atlantoaxial joint atlantoaxial joint instability CT signs, to explore the reliability of the craniocervical junction to ligament MR signal classification method, the analysis of the instability of the craniocervical junction clinical manifestations and anatomy relevant factors'. Materials and Methods: A prospective analysis of 242 cases of cervical CT data All patients were cross-sectional volume scanning, the original data is transmitted to the workstation, multi-planar reconstruction technique to obtain vector crown axial images, meet the inclusion criteria were included in the craniocervical junction District instability group and Get volume rendering restructuring diagram, and another randomly selected 50 age-and sex-matched asymptomatic people doing normal control. The two groups of patients underwent high-resolution MR proton sequence scan. Share of cross-section based on PDWI ligament high-signal areas the proportion of the alar ligament, transverse ligament, the coated the subdural composite body, atlanto-occipital membrane the subdural composite body change into 0 to 2. Double-blind method, two physician weeks apart ligament MR signal classification, and evaluate the results of the consistency and repeatability Kappa test. Results: 242 cases were screened out craniocervical junction instability of the 60 cases, pillow atlantoaxial joint atlantoaxial joint instability were 21 and 39 cases. 34 males and 26 females, aged 14 to 67 years, an average of 38 years old. Based on the the occipital condyle shift direction, 21 cases of occipital atlanto joint instability can be divided into three types: 13 cases of unilateral occipital condyle rotary-type instability, occipital condyle after displaced instability five cases, after the shift - rotating composite instability in 3 cases. Sagittal MPR image the joints leading edge cortical bone connection backward angle fold, the joints appear before a step-like change; seven cases coronal plane shows the same direction of bilateral occipital atlanto joint dislocation; 11 patients with axial MPR image shows a narrow triangular gap sign. 15 patients with cervical foraminal deformation, 15 cases of atlas the zygapophysial rear flat. According to the atlas shift direction and rotation state, 39 cases of atlantoaxial joint instability can be divided into four types: the atlas displaced instability seven cases, the lateral displacement instability six cases, rotary instability of five cases , 21 cases of compound instability. Multi-planar reconstruction CT:, seven cases atlantoodontoid, gap widened 3.5 ~ 5.7mm, an average of 4.3mm. 32 cases of odontoid side shift distance 1.5 ~ 2.2mm, an average of 1.8mm. The bilateral atlantoaxial articular surface with dislocation 16 cases. VR Figure 26 cases of atlas rotation to the left or to the right. 3 patients with osteoarthritis of the atlantoaxial joint edge of the huge spur broke into the neck foraminal so narrow, 37 patients with cervical transforaminal no significant stenosis. 60 cases, 7 cases with cervical developmental abnormalities: four cases of atlanto-occipital membrane immature, 3 cases of bilateral the single flank ligament immature. Application our ligament classification system, two physicians alar ligament, transverse ligament complex assessment of coating subdural consistency and repeatability weighted Kappa values ??gt; 0.6; atlanto-occipital membrane subdural composite poor or poor body assess the consistency and repeatability the Weighted Kappa lt; 0.4. Alar ligament, transverse ligament complex coating subdural incidence of 1 to 2 study group than the control group (P lt; 0.05). The coated the subdural composite body grading pillow atlantoaxial joint instability and atlantoaxial joint instability was no significant difference between the two groups. Alar ligament lesions (1 to 2) and odontoid side shift related. Transverse ligament lesions (1 to 2) associated with the former atlantoodontoid gap widened. Conclusion: CT thin layer spiral scan MPR technology with MR high-resolution proton sequence in combination, can be a comprehensive assessment of the craniocervical junction instability bone muscle, ligament morphological changes. 0 to 2 ligament grading system can reliably reflect the extent of the ligament lesions. Alar ligament, transverse ligament, film pillow atlantoaxial joint atlantoaxial joint stable support structure.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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