Multidetector computed tomography and magnetic resonance imaging evaluation of craniovertebral junction abnormalities

Abstract

Background:Craniovertebral junction (CVJ) abnormalities constitute an important group of treatable neurological disorders with diagnostic dilemma. Their precise diagnosis, identification of probable etiology, and pretreatment evaluation significantly affects prognosis and quality of life of patients.Aims:The study was to classify various craniovertebral junction disorders according to their etiology and to define the importance of precise diagnosis for pretreatment evaluation with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI).Materials and Methods:This is a prospective observational study of 62 patients referred to our department between October 2012 and September 2014. All patients suspected to have a craniovertebral junction disorder were included in the study, from all age groups and both genders. Detailed clinical history was taken. Radiographs of cervical spine were collected if available. All patients were subjected to MDCT and/or MRI.Results:In our study of 62 patients; 39 were males and 23 were females, with male to female ratio of 1.6:1. Most common age group was 2nd -3rd decade (19 patients, 30.64%). Developmental anomalies (33 patients, 53.22%) were the most common etiology group followed by traumatic (10 patients, 16.12%), degenerative (eight patients, 12.90%), infective (four patients, 6.45%), inflammatory and neoplastic (three patients each, 4.8%), and no cause found in one patient.Conclusions:CVJ abnormalities constitute an important group of treatable neurological disorders, especially in certain ethnic groups and are approached with much caution by clinicians. Thus, it is essential that radiologists should be able to make a precise diagnosis of craniovertebral junction abnormalities, classify them into etiological group, and rule out important mimickers on MDCT and/or MRI, as this information ultimately helps determine the management of such abnormalities, prognosis, and quality of life of patients.

Imaging of Developmental Malformations Affecting Craniocervical Junction

“…The study of Talukdar et al [7] was conducted on 46 cases of CVJ abnormalities, 28 cases (61%) were congenital anomalies, while our study was conducted on 30 patients with developmental anomalies in the craniocervical junction. Developmental etiology was the most common cause of CCJ anomalies in the study conducted by Dhadve et al [8] and Singh et al [6] .…”

Revealing an Uncommon Presentation of Chiari I Malformation With Diverse Craniovertebral Anomalies in the Absence of Syringomyelia and Atlanto-Occipital Subluxation: A Case Report

“…The CVJ exhibits a variety of bony abnormalities [ 4 ]. The clinical manifestations vary, including chronic headaches, restricted neck motion, and neurological deficits [ 2 ]. The CVJ anomalies are frequently linked with conditions such as Chiari malformation, Klippel-Feil syndrome, and syringomyelia [ 4 , 6 ].…”

“…CT gives superior visualization of the osseous structures. MRI additionally gives information regarding the surrounding soft-tissue structures around the CVJ [ 2 ].…”

“…For its diagnosis on radiological imaging, the tip of the dens protrudes more than 7 mm above McGregor's basal line or 5 mm above Chamberlain's line [ 4 ]. The primary form is congenital, while secondary basilar invagination, or basilar impression, is associated with skull base softening due to an acquired disease [ 2 ].…”

“…The craniovertebral junction (CVJ) serves as the crucial interface between the spine and the skull, comprising various bony and soft tissue structures [ 1 ]. Anomalies in this region can lead to diverse clinical manifestations, from headaches to neurological deficits, necessitating a thorough understanding and precise radiological assessment [ 2 ].…”