Diagnostic Utility of Increased STIR Signal in the Posterior Atlanto-Occipital and Atlantoaxial Membrane Complex on MRI in Acute C1–C2 Fracture

Chang, Yu‐Ming; Kim, G.; Peri, Nagamani; Papavassiliou, Efstathios; Rojas, Rafael; Bhadelia, Rafeeque A.

doi:10.3174/ajnr.a5284

Cited by 10 publications

(4 citation statements)

References 21 publications

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“…Minor CCJ ligament injuries involving the anterior atlanto-occipital membrane complex (AAOMc) or posterior atlanto-occipital membrane complex (PAOMc) were more common and present in 76% of patients (Figure 3A-3D). CT: computed tomography; MVA: motor vehicle accident; MRI: magnetic resonance imaging; STIR: short tau inversion recovery However, Chang et al recently investigated the utility of isolated increased STIR signal in the PAOMc on MRI as a secondary finding of C1-C2 fractures with a high sensitivity (89.7%) [13]. Given that 59% of our patient cohort exhibited a C1-C2 fracture, increased STIR signal may have been a secondary finding related to a bony fracture rather than a primary ligamentous injury of the AAOMc and PAOMc.…”

Section: Resultsmentioning

confidence: 99%

“…However, Chang et al. recently investigated the utility of isolated increased STIR signal in the PAOMc on MRI as a secondary finding of C1-C2 fractures with a high sensitivity (89.7%) [ 13 ]. Given that 59% of our patient cohort exhibited a C1-C2 fracture, increased STIR signal may have been a secondary finding related to a bony fracture rather than a primary ligamentous injury of the AAOMc and PAOMc.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the minor CCJ proper ligaments, namely, the AAOMc and PAOMc, are thought to play a nominal role in maintaining CCJ integrity. Increased STIR signal within the PAOMc is not uncommonly seen in the setting of a C1-C2 fracture as opposed to a primary PAOMc ligamentous injury [ 4 , 5 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Interrelationship Between Craniocervical Dissociation Spectrum Injuries and Atlantoaxial Instability on Trauma Cervical MRI Examinations

Fiester¹,

Soule²,

Patel³

et al. 2022

Cureus

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Background and purposeCraniocervical dissociation injuries encompass a spectrum of osteoligamentous injuries between the skull base and C1-C2 that may be treated via prolonged external immobilization versus occipital cervical fusion depending on the risk of persistent craniocervical instability. However, the presence of atlantoaxial instability (AAI) at C1-C2, as determined by transverse atlantal ligament (TAL) integrity with or without a C1 fracture, may guide the neurosurgical management of craniocervical dissociation spectrum injuries (CDSI) since it implies an overall greater degree of instability at the craniocervical junction (CCJ). Materials and methodsAdult trauma patients who suffered a transverse atlantal ligament injury on cervical magnetic resonance imaging (MRI) were identified retrospectively. The cervical computed tomography (CT) and magnetic resonance imaging examinations for these patients were reviewed for additional traumatic findings. Demographic information, treatment, and outcome information were recorded. ResultsTwenty-nine trauma patients presented to the emergency department (ED) with an acute, midsubstance transverse atlantal ligament tear on cervical magnetic resonance imaging. Thirty-one percent of patients demonstrated a tear in at least one major craniocervical ligament (atlanto-occipital capsular ligaments, alar ligaments, and tectorial membrane {TM}) with 14% demonstrating a tear in two major craniocervical ligaments and no patients demonstrating a tear in all three major craniocervical ligaments. Minor craniocervical ligament injuries (anterior atlanto-occipital membrane complex {AAOMc} and posterior atlanto-occipital membrane complex {PAOMc}) were common and observed in 76% of patients. ConclusionsOur study suggests that multiple major craniocervical junction ligamentous injuries on cervical magnetic resonance imaging are relatively uncommon in the setting of transverse atlantal ligament injury.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Interrelationship Between Craniocervical Dissociation Spectrum Injuries and Atlantoaxial Instability on Trauma Cervical MRI Examinations

Fiester¹,

Soule²,

Patel³

et al. 2022

Cureus

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“…Chang et al. investigated the utility of isolated increased STIR signal in the PAOMc on MRI as a secondary finding of C1-C2 fractures with high sensitivity (89.7%) [ 19 ]. However, more recent research on PAOMc injury grading on cervical MRI demonstrated only half of the patients with increased STIR signal in the PAOMc had a C1-C2 fracture, and only one patient in our cohort demonstrated a C1-C2 fracture (type 2 dens fracture) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

C1-C2 Dorsal Epidural Hematoma on Cervical Spine CT: A Novel Imaging Sign of Posterior Atlanto-Occipital Membrane Stripping Injury

Fiester¹,

Soule²,

Rahmathulla³

et al. 2021

Cureus

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Background and Purpose: Identify patients with a dorsal epidural hematoma at C1-C2 and examine the major craniocervical junction ligaments for injury on follow-up magnetic resonance imaging. Materials and Methods: Adult and pediatric trauma patients who suffered a dorsal epidural hematoma at C1-C2 were identified using Nuance mPower software (Nuance Communications, United States). The cervical computed tomography and magnetic resonance imaging exams for these patients were reviewed for craniocervical junction osteoligamentous injuries. An age-matched control group was obtained. Results: Eight trauma patients were identified with a dorsal epidural fluid collection at C1-C2. All patients with a dorsal epidural hematoma, who underwent follow-up cervical magnetic resonance imaging demonstrated a stripping injury of the posterior atlanto-occipital membrane from the C1 posterior arch with increased short tau inversion recovery signal in the posterior atlanto-occipital membrane complex. Disruption of additional major craniocervcial ligaments on magnetic resonance imaging was relatively common with the most frequently associated ligamentous injuries involving the tectorial membrane (five patients) followed by the alar ligaments and anterior altanto-occiptial membrane (four patients each). Conclusions: A C1-C2 dorsal epidural hematoma is a rare injury that may be identified on cervical spine computed tomography but may be easily overlooked by the radiologist. We propose that a C1-C2 dorsal epidural hematoma is a direct result of a significant hyperflexion-hyperextension force with subsequent stripping of the posterior atlanto-occipital membrane from the posterior C1 arch. Trauma patients with a C1-C2 dorsal epidural hematoma on cervical spine computed tomography should undergo a cervical magnetic resonance imaging examination to evaluate the integrity of the posterior atlanto-occipital membrane complex and remaining craniocervical junction ligaments for injury.

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Frakturen der Halswirbelsäule und Bandscheibenläsionen

Bachhuber¹

2021

Radiologe

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Diagnostic Utility of Increased STIR Signal in the Posterior Atlanto-Occipital and Atlantoaxial Membrane Complex on MRI in Acute C1–C2 Fracture

Cited by 10 publications

References 21 publications

Interrelationship Between Craniocervical Dissociation Spectrum Injuries and Atlantoaxial Instability on Trauma Cervical MRI Examinations

Interrelationship Between Craniocervical Dissociation Spectrum Injuries and Atlantoaxial Instability on Trauma Cervical MRI Examinations

C1-C2 Dorsal Epidural Hematoma on Cervical Spine CT: A Novel Imaging Sign of Posterior Atlanto-Occipital Membrane Stripping Injury

Frakturen der Halswirbelsäule und Bandscheibenläsionen

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