Abhishek Biswas1, Nihar Ranjan Sarkar2, Alak Pandit3
BACKGROUND
The craniovertebral junction is a complex articulation between occiput, atlas, axis
and supporting ligaments enclosing the soft tissue structures of cervicomedullary
junction which includes medulla, spinal cord and lower cranial nerves. The
incidence of different types of CVJ anomalies varies with demographic
environment & ill-defined genetic factors. CVJ anomalies are more frequently
found in Indian subcontinent than anywhere else in the world. Even in India, these
anomalies are more frequently documented from Bihar, Uttar Pradesh, Rajasthan
and Gujarat. The reason for this geographical clustering is more speculative. The
CVJ anomalies can be either due to bony or soft tissue anomalies. They are
common in all age groups and almost equal in both sex groups. The anomalies
can be due to congenital or acquired causes. There has been a renewed interest
in the normal anatomy & pathological lesions of CVJ anomalies with dynamic xrays,
computed tomography (CT) and magnetic resonance imaging (MRI). The
clinical features are often delayed up to 2nd or 3rd decade, since they are subtle
and often missed. Various congenital anomalies and acquired disease processes
can affect the craniovertebral junction. They often cause diagnostic dilemmas.
Only few studies have been conducted in this regard. This study is an attempt to
define importance of precise diagnosis for pre-treatment evaluation and
systematic classification of CVJ abnormalities with MRI and multi-detector
computed tomography (MDCT).
METHODS
We conducted this cross-sectional descriptive study with 55 patients, who had
been referred to us for CT / MRI from Department of Neurology. 3 Tesla MRI (GE
Healthcare) and 16 slice MDCT (Philips) were used in this study.
RESULTS
In our study, congenital anomalies were the most common type of CVJ abnormality
followed by degenerative changes and trauma. MRI proved to be better at
detecting soft tissue abnormalities and assessing spinal cord compression,
although CT was very much accurate at demonstrating bony lesions with short
scan times and ability to reconstruct in three orthogonal planes.
CONCLUSIONS
CT and MRI cannot be compared in imaging the craniovertebral junction and
should be complementary to each other.
