RSNA 2007 

Abstract Archives of the RSNA, 2007


SSK13-08

Reassessment of the Pediatric Craniocervical Junction: Normal Values Based on Multidetector Computed Tomography

Scientific Papers

Presented on November 28, 2007
Presented as part of SSK13: Pediatric (Neuroradiology)

Participants

John Christopher Bertozzi MD, Presenter: Nothing to Disclose
Carlos Andres Rojas MD, Abstract Co-Author: Nothing to Disclose
Carlos Rodrigo Martinez MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

We aim to establish normal values on multi-detector CT (MDCT) images for various measurements used to detect craniocervical junction injuries in children and address any discrepancies with the published data based on radiographs.

METHOD AND MATERIALS

One hundred and eleven normal pediatric patients between two months and ten years of age underwent cervical spine MDCT with multiplanar reconstructions. Various accepted methods of evaluating the craniocervical junction were utilized including the basion-axial interval (BAI), basion-dens interval (BDI), Powers ratio, atlanto-dental interval (ADI), and the atlanto-occipital joint space (AOI). Normal values were established and compared to previously accepted data based on radiographs. Two examiners evaluated the patient population to establish inter-examiner variability.

RESULTS

Ninety-five percent of the population was found to have a BDI less than 10.5 mm compared to 12 mm based on data from plain radiographs. Separating the patient population into those in whom the os terminale was and was not ossified revealed a difference of 2 mm in the upper limit of the 95% inclusion range (9.5 mm and 11.5 mm, respectively). The Powers ratio demonstrated no significant difference compared to data obtained using plain radiographs in patients for whom the appropriate anatomic landmarks could be identified. Ninety-five percent of the population was found to have an ADI less than 2.6 mm when the necessary anatomic landmarks were present, compared to 4-5 mm measured on radiographs. The AOI demonstrated 95% of the population falling below 3 mm at any point within the joint space, compared to the previously accepted value of 5 mm. The BAI was difficult to reproduce on MDCT images.

CONCLUSION

Normal values for the craniocervical junction articulations as seen on MDCT are significantly different from the accepted ranges of normal based on radiographs. We suggest that these values should be considered as the normal range in the pediatric population.

CLINICAL RELEVANCE/APPLICATION

The normal values of the craniocervical relationships based on MDCT are significantly different from the accepted values based on radiographs.

Cite This Abstract

Bertozzi, J, Rojas, C, Martinez, C, Reassessment of the Pediatric Craniocervical Junction: Normal Values Based on Multidetector Computed Tomography.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5001941.html