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Understanding the Link between Body and Mind: Magnetic Resonance Imaging evaluation of Congenital Craniovertebral Junction Anomalies 2014

Category General Spine Amit Gupta, M.D. Tushar Chandra, M.D. Manish Bajaj, M.D. Ravishankar Pillenahalli maheshwarrapa, M.D. Purpose The aim of this exhibit is to : 1. Review normal anatomy and development of the structures constituting craniovertebral junction(CVJ). 2. Discuss the role of craniometry in assessment of CVJ abnormalities. 3. Empasize the role of MR imaging as a useful alternative to CT for evaluation of various CVJ anomalies encountered in clinical practice. Materials & Methods • Anatomy landmarks and development of structures forming CVJ (occiput, clivus, atlas and axis). • Basic craniometric measurements - Lines: Chamberlain line, Wackenheim clivus baseline, McGregor's line, McRae's line, Ranawat’s line. - Angles: Welcher basal angle, and atlantooccipital joint axis angle. • Status of MRI in comparison to CT scan. • CVJ evaluation on MRI with sample cases. • Imaging Mimics and differentials - Fractures - Infective/Inflammatory processes. - Bone diseases • Final Words. Results CT poses radiation hazards which can be obviated if MR is used. MR imaging with its multiplanar capability and absence of ionising radiation can be a very useful tool for assessing CVJ. It is a robust modality providing clinically useful information regarding the status of cervical cord and the hind brain in the same study. Conclusion Until recently, CVJ was a challenging region to a radiologist on MR imaging and CT has been playing the lead role. But with thorough understanding of anatomy and craniometry MRI can prove to be a useful alternative for evaluating CVJ anamolies References Smoker WRK Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographic 1994; 14:2555-77 McGregor J. The significance of certain measurements of the skull in the diagnosis of basilar impression. BrJ Radiol i948; 21:171- 181. Van Gilder JC, Menezes MI, Dolan KD. The craniovertebral junction and its abnormalities. New York, NY: Futuna, 1987. Wald SL, McLaurin RL. Anomalies of the craniocervical. junction. American Association of Neurologic Surgeons. Pediatric neurosurgery: surgery of the developing nervous system. New York: Grune and Stratton, 1982; 157-170. Osborn AG, ed: Disorders of neural tube closure. In: Diagnostic Neuroradiology. St Louis, Mo: Mosby-Year Book; 1994: 15-8. Barkovich AJ: Congenital malformation of the brain. In pediatric neuroimaging, pp 77-147, New York, Raven press, 1990