Magnetic Resonance Imaging of Pseudotumors of the Craniovertebral Junction in Long-Term Hemodialysis Patients

Abstract

Background/Aims: Pseudotumors of the craniovertebral junction (PTCVJ) are observed in long-term hemodialysis (HD) patients. There are neither criteria for diagnosis nor guidelines for screening. We attempted to determine magnetic resonance imaging (MRI) findings that could be used to detect PTCVJ, to determine the prevalence of PTCVJ, and to evaluate whether destructive spondyloarthropathy (DSA) might be a yardstick for selection of patients for MRI examination for PTCVJ. Methods: MRI were examined in 19 DSA patients (8 males, 11 females, age 61.4 ± 7.3 years, HD duration 17.0 ± 4.4 years) and in 20 sex-, age-, and HD-duration-matched non-DSA patients (9 males, 11 females, age 57.5 ± 6.6 years, HD duration 17.7 ± 4.9 years). We evaluated MRI characteristics of PTCVJ according those which occur due to rheumatoid arthritis. Results: PTCVJ were characterized as follows: disappearance of fat pads in the upper region (supradental PTCVJ), intensity change of the ‘predental triangle’ in the anterior region (predental PTCVJ), and thickening of cruciform ligaments (retrodental PTCVJ). The prevalence of PTCVJ among patients undergoing HD more than 10 years was high (26 out of 39; 66.7%). The prevalence of PTCVJ was not different between DSA and non-DSA groups. Conclusion: We verified that the above MRI findings might be helpful in the detection of PTCVJ. These findings were observed frequently and independently also in patients with DSA.

Imaging in the Dialysis Patient: Imaging in Dialysis Spondyloarthropathy

“…Inconsistent MRI findings also have been reported inhemodialyzed patients with destructive spondyloarthropathy of the occipitoatlantoaxial region. Rousselin et al (23) and Maruyama et al (46) observed persistent lowsignal intensity about the odontoid process on both T1‐weighted and T2‐weighted spin echo MRI. Other investigators have reported similar findings (16,25,33), whereas Stäbler et al (68) observed regions of high signal intensity in and about the odontoid process on gradient echo MRI.…”

“…The cause of destruction in this anatomic region may be b 2 M amyloid deposition (16,24,25,33,34). Hypertrophy of the synovium of the atlantoaxial joints, resembling the pannus of rheumatoid arthritis, produces soft tissue masses (pseudotumors) that surround the dens (16,23,34,46,47). Changes in the occipitoatlantoaxial region consist of cystic lesions in the atlas or axis, including the odontoid process (2,16,24,34,48).…”

“…Changes in the occipitoatlantoaxial region consist of cystic lesions in the atlas or axis, including the odontoid process (2,16,24,34,48). Additional findings may include erosions, resorption, and fracture of the odontoid process, resulting in atlantoaxial subluxation (16,23,25,46). The affected patient is at risk of developing severe neurologic complications that may require surgical intervention (31,33,34).…”

“…These investigators (5) postulated that contrast enhancement of the affected structures may be due to reactive inflammation around deposits of β 2 M amyloid in dialysis patients (21,41,66). Indeed, several studies (17,19,24,25,30,33,46,48,67) have reported persistence of low signal intensity in the involved spinal segments on T2‐weighted MRI, although others (5,11,22) have reported abnormal high signal intensity in the affected structures on T2‐weighted MRI (Fig. 3).…”

Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series

“…2 ROP may be associated with rheumatoid arthritis, os odontoideum, odontoid fracture, or noninflammatory conditions such as cervical degenerative changes and mechanical instability. 3-6…”