Rheumatoid arthritis of the craniocervical region: assessment and characterization of inflammatory soft tissue proliferations with unenhanced and contrast-enhanced CT

Abstract

The aim of this study was to depict and characterize inflammatory soft tissue proliferations caused by rheumatoid arthritis (RA) in the craniocervical region by unenhanced and contrast-enhanced CT. Computed tomography of the craniocervical region was performed in 35 patients in the axial plane before and after the i.v. administration of contrast material. According to the densities and contrast enhancement of the inflammatory soft tissue proliferations, four groups were classified. Ancillary findings, such as a compression of the dural sac or spinal cord, erosions of the bony structures, and atlantoaxial subluxation, were also evaluated. Inflammatory soft tissue proliferations were depicted in 28 of 35 patients and could be differentiated by unenhanced and contrast-enhanced CT according to the above defined criteria: effusion in 6 patients (17%); hypervascular pannus in 8 (23%); hypovascular pannus in 5 (14%); and fibrous tissue in 9 patients (26%). A compression of the dural sac was seen in 11 (31%) patients; 3 of these had neurological symptoms. Erosions of the odontoid process were found in 20 (57%) patients; 16 (80%) of these also showed erosions of the atlas. Atlantoaxial subluxation was seen in 11 (31%) patients. Inflammatory soft tissue proliferations in the craniocervical region caused by RA can be reliably demonstrated and classified by unenhanced and contrast-enhanced CT, which can differentiate between joint effusion and various forms of pannus and depict ancillary findings. Computed tomography is an alternative method for patients unable to undergo an MRI examination.

Radiological evaluation of cervical spine involvement in rheumatoid arthritis

“…The benefits of MRI will be discussed further below. 10,13,21,36 In Table 1 we presented a summary of the advantages and disadvantages of each imaging modality used to evaluate cervical instabilities in the setting of RA.…”

“…The normal diameter measured on lateral radiographs from C-3 to C-7 is 14-23 mm, and the diameter of the canal is a better predictor of neurological impairment than the degree of subluxation between the vertebrae. 10,12 cT with multiplanar Reconstruction…”

“…10 Dynamic CT scans can demonstrate occult instabilities, especially in the craniocervical and cervicothoracic regions that are poorly visualized by flexion-extension plain radiographs due to superimposed bony structures. 3,31 Younes et al performed a study on the prevalence of cervical spine instabilities in RA patients according to the radiological modality used.…”

Revisiting Anterior Atlantoaxial Subluxation with Overlooked Information on MR Images

“…21 On top of routine pulse sequences, we added these sequences for rheumatoid arthritis patients or those with other known inflammatory disorders. Because the study group included diverse clinical diagnoses, the short inversion recovery, fat-saturated FSE-T2-weighted, and postcontrast scanning were not used for all patients.…”

Brain Stem Compression and Atlantoaxial Instability Secondary to Chronic Rheumatoid Arthritis in a 67-Year-Old Female

“…1,2 The cervical spine is involved in up to 86% of patients with rheumatoid arthritis. [3][4][5] Patients with long-standing disease of the craniovertebral junction may have intractable pain, motor and sensory neurologic deficits, and myelopathy.…”