3D T2 MR Imaging–Based Measurements of the Posterior Cervical Thecal Sac in Flexion and Extension for Cervical Puncture

Bazylewicz, Michael; Berkowitz, Frank E.; Sayah, Anousheh

doi:10.3174/ajnr.a4564

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…To our knowledge, no one has reported normal CXA values using 3D MRI during neck flexion and extension within the scanner, although a similar approach has been used to measure the posterior cervical subarachnoid space accurately. 23…”

Section: Discussionmentioning

confidence: 99%

Normal range of clivoaxial angle in adults using flexion and extension cervical magnetic resonance imaging scans

Sayah

Farley

Munoz³

et al. 2021

Neuroradiol J

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Objective An abnormally decreased clivoaxial angle (CXA) is used during the clinical evaluation for corrective skull base surgery. Published normal ranges of CXA using x-ray, computed tomography, or magnetic resonance imaging (MRI) vary dramatically, especially with neck flexion or extension. The aim of this study was to use high-resolution MRI to determine the normal range of CXA in various neck positions using a reproducible measurement technique. Methods The CXA was measured in 10 healthy volunteers on sagittal T2 SPACE c-spine MRI in supine and prone positions and with the neck both neck and extended. CXA is strictly defined as the angle between a line along the inferior third of the dorsal clival cortex and a line from the superior/posterior cortex of the dens to the posterior/inferior corner of the C2 body. Statistical analysis was performed in all positions and included mean CXA, range, standard deviation ( SD), inter-reader agreement, and group comparisons. Results The mean CXA overall was 156.92° ( SD=4.23°; range 134–179°). The mean value for extension CXA was 169.20° ( SD=5.81°), and the mean value for flexion CXA was 144.73° ( SD=5.71°), the difference being statistically significant ( p<0.0001) regardless of supine or prone position. Concordant correlations of reader measurements showed substantial agreement in the supine position at 0.96, with lower agreement in the prone position at 0.87. Conclusions We report normal ranges for CXA in various neck positions based on 3D T2-weighted MRI, using a reproducible measurement method. There was a significant difference in the CXA values between neck extended and neck flexed positions but not between supine and prone positions.

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Section: Discussionmentioning

confidence: 99%

Normal range of clivoaxial angle in adults using flexion and extension cervical magnetic resonance imaging scans

Sayah

Farley

Munoz³

et al. 2021

Neuroradiol J

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“…For this purpose, it is used for the detection of cerebellar tonsillar movement in Chiari I malformation, evaluation of arachnoid granulations, evaluation of third ventriculostomy patency, determination of etiology of hydrocephalus, and localization of spinal dural arteriovenous fistulas (5,6,(14)(15)(16). Besides, there are studies showing normal anatomy at the cervical spinal level both statically and dynamically (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of craniocervical pseudomeningoceles with three-dimensional T2-SPACE sequence at 3T

et al. 2020

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Background Pseudomingocele is a postoperative fluid collection adjacent to the dural membrane. The distinction of pseudomeningocele from other postoperative collections is very important. Purpose To show the efficacy of three-dimensional (3D) T2-weighted sampling perfection with application-optimized contrasts using a different flip-angle evolution (SPACE) magnetic resonance imaging (MRI) sequence in the diagnosis of pseudomeningocele in which conventional MRI sequences may be insufficient. Material and Methods A total of 10 patients were included in the study. All of these patients also had 3D T2-SPACE high-resolution volumetric MR image in addition to conventional cervical and cerebral MR sequences. All MR examinations were reviewed by two neuroradiologists. Results Pseudomeningocele neck was shown in six patients by both conventional sequences and SPACE sequence. In two patients, the neck was only shown in the SPACE sequence. Four pseudomeningocele necks were shown to have flow void with both conventional sequences and SPACE sequence. Flow void could only be demonstrated by SPACE sequence in two patients. Conclusion A T2-SPACE sequence can show the presence of pseudomeningocele neck and flow void even in cases where conventional MRI cannot show, thus contributing to the diagnosis of pseudomeningocele. Therefore, especially in postoperative imaging, the T2-SPACE sequence may be included in routine sequences to make the differential diagnosis correctly.

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“…Our absolute measurements of the width of the SAS are nearly identical to an MRI study, which reported a widening of the posterior SAS on average from 0.4 cm in neutral position to 0.5 cm in extension. 8 The head position -SAS width index seems to be a parameter sensitive to detect this phenomenon independent of variations of the width of the spinal canal and the SAS between individuals.…”

Section: Discussionmentioning

confidence: 99%

“…That spinal level is of special interest for radiologists performing a myelography at C1-C2. We compared the SAS in different head positions because previous radiological and magnetic resonance imaging (MRI) studies have shown that the posterior cerebrospinal fluid space enlarges with the head in extension position, which can facilitate the dural puncture 8,9 …”

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confidence: 99%

In Vivo Ultrasound Imaging of the Spinal Cord and Subarachnoid Space at the C1-C2 Level in Healthy Adult Subjects

Beland

McElroy

Brinker

et al. 2020

Ultrasound Quarterly

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Ultrasound (US) imaging of the spinal canal is applied in early infants before formation of posterior spine bony elements. Here, we demonstrate for the first time in adult healthy subjects that excellent visualization of intrathecal structures at the level of C1-C2 is possible by transcutaneous US in flexion, extension, and neutral head positions through the soft tissue US window between C1-C2. We show with US that the posterior subarachnoid space increases significantly in head extension. Accordingly, C1-C2 US guidance can facilitate cervical myelography. In addition, we suggest that US of the C1-C2 spine level may offer an adjunct tool to diagnosing structural abnormalities in the setting of traumatic, congenital, or degenerative pathologies of the craniocervical junction.

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3D T2 MR Imaging–Based Measurements of the Posterior Cervical Thecal Sac in Flexion and Extension for Cervical Puncture

Cited by 7 publications

References 14 publications

Normal range of clivoaxial angle in adults using flexion and extension cervical magnetic resonance imaging scans

Normal range of clivoaxial angle in adults using flexion and extension cervical magnetic resonance imaging scans

Evaluation of craniocervical pseudomeningoceles with three-dimensional T2-SPACE sequence at 3T

In Vivo Ultrasound Imaging of the Spinal Cord and Subarachnoid Space at the C1-C2 Level in Healthy Adult Subjects

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