Radiological Evaluation of Cervical Spine Involvement in RA
Radiological Evaluation of Cervical Spine Involvement in RA
Routine plain radiographs are recommended for screening cervical instabilities in patients with RA, because there is a high prevalence of involvement and this imaging modality is widely available and relatively inexpensive. The standard plain radiographic screening views include upright anteroposterior, lateral, and flexion-extension views and an open-mouth view for odontoid visualization. Bone alignment, quality, and deformities can easily be assessed with plain radiographs, but plain radiographs are limited in their ability to visualize bony erosions, the craniocervical and cervicothoracic junctions (due to superimposition of the cranial base structures and the glenohumeral joints), and soft tissue abnormalities such as pannus and spinal cord compression. If any cervical spine disease is suspected or confirmed with plain radiographs or the patient has any neurological symptom or important cervical pain, then CT and/or MRI examination of the cervical spine is indicated.
A CT scan with multiplanar reconstruction is the method of choice for detailed bony evaluation (including visualization of erosions, anatomy, and the presence of ankylosis and pseudarthrosis). For this reason, CT is important for surgical planning. However, soft tissue evaluation is limited in this imaging modality, and its ability to visualize the spinal cord and the nerve roots is poor.
Finally, MRI is the most sensitive modality for detection of cervical spine involvement in RA and should be performed in all patients with anomalies detected or suspected on plain radiographs. A cervical MRI study should also be performed in all patients with myelopathy or radiculopathy. The benefits of MRI will be discussed further below.
In Table 1 we presented a summary of the advantages and disadvantages of each imaging modality used to evaluate cervical instabilities in the setting of RA.
Overview of Imaging Modalities for Diagnosing Cervical Instabilities
Routine plain radiographs are recommended for screening cervical instabilities in patients with RA, because there is a high prevalence of involvement and this imaging modality is widely available and relatively inexpensive. The standard plain radiographic screening views include upright anteroposterior, lateral, and flexion-extension views and an open-mouth view for odontoid visualization. Bone alignment, quality, and deformities can easily be assessed with plain radiographs, but plain radiographs are limited in their ability to visualize bony erosions, the craniocervical and cervicothoracic junctions (due to superimposition of the cranial base structures and the glenohumeral joints), and soft tissue abnormalities such as pannus and spinal cord compression. If any cervical spine disease is suspected or confirmed with plain radiographs or the patient has any neurological symptom or important cervical pain, then CT and/or MRI examination of the cervical spine is indicated.
A CT scan with multiplanar reconstruction is the method of choice for detailed bony evaluation (including visualization of erosions, anatomy, and the presence of ankylosis and pseudarthrosis). For this reason, CT is important for surgical planning. However, soft tissue evaluation is limited in this imaging modality, and its ability to visualize the spinal cord and the nerve roots is poor.
Finally, MRI is the most sensitive modality for detection of cervical spine involvement in RA and should be performed in all patients with anomalies detected or suspected on plain radiographs. A cervical MRI study should also be performed in all patients with myelopathy or radiculopathy. The benefits of MRI will be discussed further below.
In Table 1 we presented a summary of the advantages and disadvantages of each imaging modality used to evaluate cervical instabilities in the setting of RA.
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