CT and MR imaging of odontoid abnormalities: A pictorial review

Jain, Nishchint; Verma, Ritu; Garga, Umesh Chandra; Baruah, Barinder P; Jain, Sachin; Bhaskar, Sapnashree

doi:10.4103/0971-3026.178358

Cited by 35 publications

(28 citation statements)

References 53 publications

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“…The distance from the odontoid tip to the CL is the most widely used index for diagnosing BI [ 11 , 14 ]. Generally, a CL value ≥ 5 mm is suggestive of BI [ 5 , 12 , 15 , 16 ]. In contrast, using a CL value of 2.5 mm as the criterion may produce a relatively high false positive rate [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The CPA proposed in this study is a naturally existing angle formed by the hard palate line and the Wackenheim clivus line. Interestingly, although the hard palate line has been used in the Bull angle and modified Omega angle and the Wackenheim line has been widely used to evaluate CVJ abnormalities, the CPA, formed at the intersection of these two lines, has not been proposed for use in this regard before [ 9 , 15 , 18 – 21 ]. Our study demonstrated that CPA could accurately reflect the changes of craniovertebral angle.…”

Section: Discussionmentioning

confidence: 99%

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Clivopalate angle: a new diagnostic method for basilar invagination at magnetic resonance imaging

Guo

et al. 2019

Eur Radiol

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Objectives To investigate the diagnostic value of clivopalate angle (CPA) for basilar invagination (BI) at magnetic resonance imaging (MRI). Methods In this retrospective case-control study, CPA, clivodens angle (CDA), and clivoaxial angle (CXA) were measured on midsagittal MR images from 112 patients with BI (22 men; mean age, 43.9 years ± 13.1 years; range, 21–79 years) and 200 control subjects (57 men; mean age, 47.1 years ± 13.3 years; range, 20–80 years). Intraclass correlation coefficient (ICC), linear regression, Mann-Whitney U test, binary logistic regression, and receiver operating characteristic (ROC) curve were used for statistical analysis. Results Clivopalate angle showed better inter-observer agreement (ICC = 0.951) than CXA (0.867) or CDA (0.853). CPA significantly correlated with CXA ( R = 0.811, p < 0.001) and CDA ( R = 0.716, p < 0.001). Patients with BI had a significantly smaller CPA (45.9° ± 9.9°) than control subjects (61.9° ± 6.2°) ( p < 0.001). With the optimal cutoff value of 53.5°, CPA had a sensitivity of 0.839 (94/112) and a specificity of 0.915 (183/200). The area under the ROC curve (AUC) was 0.937 (95% CI, 0.911–0.963) for CPA, which was similar to that of CXA (AUC, 0.957; 95% CI, 0.936–0.978) or CDA (AUC, 0.925; 95% CI, 0.892–0.957). The combination of CPA and CDA or CXA showed a higher diagnostic value than CDA or CXA alone. Conclusions The diagnostic performance of CPA was similar to that of CXA or CDA, but CPA might be more reliable in evaluation of BI. CPA provided complementary information to CXA and CDA. Key Points • Clivopalate angle has a high diagnostic value for basilar invagination. • Clivopalate angle demonstrates high inter-reader agreement than does clivoaxial angle or clivodens angle. • Clivopalate angle provides complementary information to clivoaxial angle and clivodens angle. Electronic supplementary material The online version of this article (10.1007/s00330-018-5972-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clivopalate angle: a new diagnostic method for basilar invagination at magnetic resonance imaging

Guo

et al. 2019

Eur Radiol

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“…This is partly because of the unusually complex anatomy of atlantoaxial joint, which is a combination of three synovial joints, making the interpretation of routine diagnostic images, quite difficult 18. Due to this complex bony and ligamentous anatomy, imaging of the odontoid peg continues to be a challenge 19. Discussing the case with a neuroradiologist with the diagnostic suspicions helps correct protocol to be sequenced, to delineate the base of the skull and upper cervical spine.…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of odontoid peg osteomyelitis with bilateral X and XII cranial nerve palsies

Chaudhry¹,

Raza

Ahmad

2019

BMJ Case Rep

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Upper cervical osteomyelitis is rare. Its presenting features are fever and neck pain, but rarely it can involve lower nerves. MRI is the main imaging modality, but it is difficult to interpret due to the unique anatomy of C1 and C2 vertebra and complex intervertebral joint. We describe a case of a 67-year-old woman, who presented with the complaint of loss of voice, neck pain and fever for 5 days. Despite repeated imaging of neck, the diagnosis was not reached. As the patient’s condition continued to deteriorate, clinical signs of bilateral 10th and 12th cranial nerve paralysis appeared and lead to a focused workup for base of skull pathology. Discussion with the radiologist helped guide the imaging protocol, which leads to the correct diagnosis being made. Treatment was tailored by blood cultures and available images. Temporary immobilisation with a cervical collar and a total of 12 weeks of antibiotics lead to complete remission.

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“…The transverse ligament provides atlanto-axial stability and often contains fibrocartilaginous tissue as an adaptation to bony compression [ 9 10 ]. The hyperintense signal on the T2-weighted images could represent fibrocartilaginous metaplasia or cystic degeneration of the ligament.…”

Section: Discussionmentioning

confidence: 99%

Retro-Odontoid Pseudotumor in a Patient with Atlanto-Occipital Assimilation

Buttiens

Vandevenne

Cauter

2018

Journal of the Belgian Society of Radiology

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A retro-odontoid pseudotumor is an uncommon non-neoplastic mass. They are mostly associated with rheumatoid arthritis and atlanto-axial subluxation. The pathogenesis is degeneration of the transverse ligament due to chronic mechanical stress. In this case report, an atlanto-occipital assimilation altered the biomechanics of the cervical spine, causing chronic mechanical stress on the transverse ligament and subsequently the development of a retro-odontoid pseudotumor. This is in accordance with previous studies that have attributed the development of retro-odontoid pseudotumor to a loss of mobility of the cervical spine, in cases without associated rheumatoid arthritis or atlanto-axial subluxation.

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CT and MR imaging of odontoid abnormalities: A pictorial review

Cited by 35 publications

References 53 publications

Clivopalate angle: a new diagnostic method for basilar invagination at magnetic resonance imaging

Clivopalate angle: a new diagnostic method for basilar invagination at magnetic resonance imaging

Delayed diagnosis of odontoid peg osteomyelitis with bilateral X and XII cranial nerve palsies

Retro-Odontoid Pseudotumor in a Patient with Atlanto-Occipital Assimilation

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