Assessment of the internal craniocervical ligaments with a new magnetic resonance imaging sequence: three-dimensional turbo spin echo with variable flip-angle distribution (SPACE)

Baumert, Bernhard; Wörtler, Klaus; Steffinger, Denise; Schmidt, Gerwin P.; Reiser, Maximilian; Baur‐Melnyk, Andrea

doi:10.1016/j.mri.2009.01.012

Cited by 57 publications

(37 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The excellent resolution and ability to view and reformat the images in any plane was stressed. Similarly, its usefulness for the visualisation of the craniocervical ligaments owing to its 3D multiplanar capabilities was recently stressed [11].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions sequence for routine imaging of the spine: preliminary experience

Tins¹,

Cassar‐Pullicino²,

Haddaway³

et al. 2012

The British Journal of Radiology

View full text Add to dashboard Cite

Objectives: The bulk of spinal imaging is still performed with conventional twodimensional sequences. This study assesses the suitability of three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions (SPACE) sequence for routine spinal imaging. Methods: 62 MRI examinations of the spine were evaluated by 2 examiners in consensus for the depiction of anatomy and presence of artefact. We noted pathologies that might be missed using the SPACE sequence only or the SPACE and a sagittal T 1 weighted sequence. The reference standards were sagittal and axial T 1 weighted and T 2 weighted sequences. At a later date the evaluation was repeated by one of the original examiners and an additional examiner. Results: There was good agreement of the single evaluations and consensus evaluation for the conventional sequences: k.0.8, confidence interval (CI).0.6-1.0. For the SPACE sequence, depiction of anatomy was very good for 84% of cases, with high interobserver agreement, but there was poor interobserver agreement for other cases. For artefact assessment of SPACE, k50.92, CI50.92-1.0. The SPACE sequence was superior to conventional sequences for depiction of anatomy and artefact resistance. The SPACE sequence occasionally missed bone marrow oedema. In conjunction with sagittal T 1 weighted sequences, no abnormality was missed. The isotropic SPACE sequence was superior to conventional sequences in imaging difficult anatomy such as in scoliosis and spondylolysis. Conclusion: The SPACE sequence allows excellent assessment of anatomy owing to high spatial resolution and resistance to artefact. The sensitivity for bone marrow abnormalities is limited. Conventional MRI protocols of the spine often consist of T 1 weighted and T 2 weighted sagittal and axial sequences. The axial images are acquired as blocks or parallel to an intervertebral disc space.A number of imaging centres use three-dimensional (3D) T 2 weighted sequences for imaging of the spine; however, these sequences are used for assessment in the axial plane only [1,2]. With older sequence types there have been compromises in the signal-to-noise ratio, spatial resolution and contrast resolution, although the advantage of the 3D reconstruction ability has been recognised [3,4]. Various sequences have been assessed for suitability, with particular emphasis on the depiction of the intervertebral foramina [1,4,5]. There has also been interest in imaging the whole spine with T 2 weighting-based 3D sequences [6].The 3D sampling perfection with application-optimised contrasts using different flip angle evolutions (SPACE) sequence is a turbo spin-echo T 2 weighted 3D sequence using variable flip angles for refocusing instead of the conventional 180 u refocusing pulse.The aim of this study was to assess the suitability of the 3D SPACE sequence for imaging of the spine. The isotropic 3D SPACE sequence was evaluated in its delineation of anatomy and pathology, particularly in anatomically difficult locations. The capacity to ...

show abstract

Section: Discussionmentioning

confidence: 99%

“…The 3D SPACE sequence offers reasonable soft tissue signal intensities and contrast resolution, and is not limited to myelography such as is representation of the spine seen with some other 3D gradient echo sequences [7,10,11].…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions sequence for routine imaging of the spine: preliminary experience

Tins¹,

Cassar‐Pullicino²,

Haddaway³

et al. 2012

The British Journal of Radiology

View full text Add to dashboard Cite

show abstract

“…Parameters for 3D SPACE sequence were repetition time = 1,500 ms, echo time 125 ms, voxel size of 0.9 mm to obtain an isotropic resolution, flip-angle = 100°, matrix = 320 9 320, field of view = 28 cm). Acquisition time was 6 min 15 s with a sagittal slab orientation [1,7,10].…”

Section: Methodsmentioning

confidence: 99%

Is spinal stenosis assessment dependent on slice orientation? A magnetic resonance imaging study

et al. 2011

View full text Add to dashboard Cite

Introduction Lumbar spinal stenosis (LSS) treatment is based primarily on the clinical criteria providing that imaging confirms radiological stenosis. The radiological measurement more commonly used is the dural sac crosssectional area (DSCA). It has been recently shown that grading stenosis based on the morphology of the dural sac as seen on axial T2 MRI images, better reflects severity of stenosis than DSCA and is of prognostic value. This radiological prospective study investigates the variability of surface measurements and morphological grading of stenosis for varying degrees of angulation of the T2 axial images relative to the disc space as observed in clinical practice. Materials and methods Lumbar spine TSE T2 threedimensional (3D) MRI sequences were obtained from 32 consecutive patients presenting with either suspected spinal stenosis or low back pain. Axial reconstructions using the OsiriX software at 0°, 10°, 20°and 30°relative to the disc space orientation were obtained for a total of 97 levels. For each level, DSCA was digitally measured and stenosis was graded according to the 4-point (A-D) morphological grading by two observers. Results A good interobserver agreement was found in grade evaluation of stenosis (k = 0.71). DSCA varied significantly as the slice orientation increased from 0°to ?10°, ?20°and ?30°at each level examined (P \ 0.0001) (-15 to ?32% at 10°, -24 to ?143% at 20°a nd -29 to ?231% at 30°of slice orientation). Stenosis definition based on the surface measurements changed in 39 out of the 97 levels studied, whereas the morphology grade was modified only in two levels (P \ 0.01). Discussion The need to obtain continuous slices using the classical 2D MRI acquisition technique entails often at least a 10°slice inclination relative to one of the studied discs. Even at this low angulation, we found a significantly statistical difference between surface changes and morphological grading change. In clinical practice, given the above findings, it might therefore not be necessary to align the axial cuts to each individual disc level which could be more time-consuming than obtaining a single series of axial cuts perpendicular to the middle of the lumbar spine or to the most stenotic level. In conclusion, morphological grading seems to offer an alternative means of assessing severity of spinal stenosis that is little affected by image acquisition technique.

show abstract

“…7B-D). 2 Functionally, the alar ligaments play an important role in strapping the occiput-C1-C2 complex together. 9 As a pair, the alar ligaments limit axial rotation and lateral flexion of the occiput in relation to the axis.…”

Section: Functional Anatomy and Biomechanicsmentioning

confidence: 99%

“…4,5,7 The normal ligament appears hypointense in both T1-and T2-weighted MR images, and its rupture is usually inferred by a discontinuity of the expected dark signal. 2 This task is complicated by the uncertain orientations of the 2 ligaments in relationship to the dens and to each other. Thus in the coronal MRI, the 2 ligaments would be "captured" in the same cut if they are lined up in a straight transverse plane, but not if they diverge dorsally or ventrally.…”

Section: Imaging Diagnosismentioning

confidence: 99%

Isolated unilateral rupture of the alar ligament

Wong

Ernest

Fan

et al. 2014

PED

View full text Add to dashboard Cite

Only 6 cases of isolated unilateral rupture of the alar ligament have been previously reported. The authors report a new case and review the literature, morbid anatomy, and pathogenesis of this rare injury. The patient in their case, a 9-year-old girl, fell head first from a height of 5 feet off the ground. She presented with neck pain, a leftward head tilt, and severe limitation of right rotation, extension, and right lateral flexion of the neck. Plain radiographs and CT revealed no fracture but a shift of the dens toward the right lateral mass of C-1. Magnetic resonance imaging of the cervical spine showed signal hyperintensity within the left dens-atlas space on both T1- and T2-weighted sequences and interruption of the expected dark signal representing the left alar ligament, suggestive of its rupture. After 12 weeks of immobilization in a Guilford brace, MRI showed lessened dens deviation, and the patient attained full and painless neck motion. Including the patient in this case, the 7 patients with this injury were between 5 and 21 years old, sustained the injury in traffic accidents or falls, presented with marked neck pain, and were treated with external immobilization. All patients had good clinical outcome. The mechanism of injury is hyperflexion with rotation. Isolated unilateral alar ligament rupture is a diagnosis made by excluding associated fracture, dislocation, or disruption of other major ligamentous structures in the craniovertebral junction. CT and MRI are essential in establishing the diagnosis. External immobilization is adequate treatment.

show abstract

Assessment of the internal craniocervical ligaments with a new magnetic resonance imaging sequence: three-dimensional turbo spin echo with variable flip-angle distribution (SPACE)

Cited by 57 publications

References 30 publications

Three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions sequence for routine imaging of the spine: preliminary experience

Three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions sequence for routine imaging of the spine: preliminary experience

Is spinal stenosis assessment dependent on slice orientation? A magnetic resonance imaging study

Isolated unilateral rupture of the alar ligament

Contact Info

Product

Resources

About