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Morimoto LR, Kase DT, Esmanhotto PG, Maciel MA, Augusto ACL, Catricala PF, Anaya JEC, Mukherjee S, Fernandes ARC, Aihara AY. Imaging Assessment of Nontraumatic Pathologic Conditions at the Craniovertebral Junction: A Comprehensive Review. Radiographics 2024; 44:e230137. [PMID: 38635454 DOI: 10.1148/rg.230137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Nontraumatic pathologic conditions of the craniovertebral junction encompass a range of conditions affecting the complex anatomy of this region without direct physical injury. These conditions include congenital syndromes that predispose individuals to ligamentous laxity, potentially leading to instability. Additionally, rare but noteworthy cases such as Grisel syndrome, a cause of pediatric torticollis, may arise without a traumatic trigger. Inflammatory diseases, including rheumatoid arthritis, ankylosing spondylitis, and crystal deposition, can lead to cervical instability and spinal cord compression. Infections at the upper cervical spine are dominated by tuberculosis, typically transmitted through hematologic or lymphatic routes with characteristic imaging findings. On the other hand, purulent bacterial infections in this area are rare. Furthermore, although tumors involving the structures of the craniovertebral junction are infrequent, they can lead to significant complications, albeit less frequently through cord compression and more commonly via pathologic fractures or subluxation. The craniocervical junction is a complex anatomic region comprising ligaments, bones, joints, and muscles that support the head's weight and enable its wide range of motion. Accurate recognition and understanding of the complex anatomy and the various nontraumatic pathologic conditions at the craniovertebral junction are pivotal for initiating timely and appropriate treatment strategies. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Letícia R Morimoto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Daisy T Kase
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Paola G Esmanhotto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Murilo A Maciel
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Ana C L Augusto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Patrick F Catricala
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Julia E C Anaya
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Sugoto Mukherjee
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Artur R C Fernandes
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - André Y Aihara
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
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Tsujioka Y, Nishimura G, Sugimoto H, Nozaki T, Kono T, Jinzaki M. Imaging findings of juvenile idiopathic arthritis and autoinflammatory diseases in children. Jpn J Radiol 2023; 41:1186-1207. [PMID: 37329408 PMCID: PMC10613601 DOI: 10.1007/s11604-023-01447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/10/2023] [Indexed: 06/19/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is a collective term for pediatric inflammatory arthritis of unknown etiology, which presents diverse clinical and imaging findings. The pathogenesis is complex; however, most cases stem from an autoimmune mechanism. Herein we provide a short review of imaging findings of JIA. Imaging assessment begins with plain radiography demonstrating joint swelling, periarticular osteopenia, and juxtaarticular bone erosion. Bone erosion occurs later in JIA. Instead, aberrant epimetaphyseal growth often gives the first clue to the diagnosis. US and MRI can demonstrate the details of the synovium, cartilage, and subchondral bone. JIA is subdivided into oligoarthritis, polyarthritis (rheumatoid factor-negative and positive), psoriatic arthritis, enthesitis-related arthritis, and systemic JIA. Awareness of the different clinical characteristics, pathogenic background, and prognosis of each subtype facilitates a more advanced, imaging-based diagnosis. Unlike the other types, systemic JIA is an autoinflammatory disease accompanied by inflammatory cytokinemia and systemic symptoms stemming from aberrant activation of the innate immunity. Other autoinflammatory diseases, both monogenic (e.g., NOMID/CINCA) and multifactorial (e.g., CRMO), are also discussed.
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Affiliation(s)
- Yuko Tsujioka
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-0016, Japan.
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
| | - Gen Nishimura
- Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan
| | | | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-0016, Japan
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-0016, Japan
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Sudoł-Szopińska I, Herregods N, Doria AS, Taljanovic MS, Gietka P, Tzaribachev N, Klauser AS. Advances in Musculoskeletal Imaging in Juvenile Idiopathic Arthritis. Biomedicines 2022; 10:biomedicines10102417. [PMID: 36289680 PMCID: PMC9598961 DOI: 10.3390/biomedicines10102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Over the past decade, imaging of inflammatory arthritis in juvenile arthropathies has significantly advanced due to technological improvements in the imaging modalities and elaboration of imaging recommendations and protocols through systematic international collaboration. This review presents the latest developments in ultrasound (US) and magnetic resonance imaging (MRI) of the peripheral and axial joints in juvenile idiopathic arthritis. In the field of US, the ultra-wideband and ultra-high-frequency transducers provide outstanding spatial resolution. The more sensitive Doppler options further improve the assessment and quantification of the vascularization of inflamed tissues, and shear wave elastography enables the diagnosis of tissue stiffness. Concerning MRI, substantial progress has been achieved due to technological improvements in combination with the development of semiquantitative scoring systems for the assessment of inflammation and the introduction of new definitions addressing the pediatric population. New solutions, such as superb microflow imaging, shear wave elastography, volume-interpolated breath-hold examination, and MRI-based synthetic computed tomography open new diagnostic possibilities and, at the same time, pose new challenges in terms of clinical applications and the interpretation of findings.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
- Correspondence:
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Andrea S. Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University Avenue, Toronto, ON M5G 1X8, Canada
| | - Mihra S. Taljanovic
- Department of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Piotr Gietka
- Clinic of Paediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Nikolay Tzaribachev
- Pediatric Rheumatology Research Institute, Achtern Dieck 7, 24576 Bad Bramstedt, Germany
| | - Andrea Sabine Klauser
- Rheumatology and Sports Imaging, Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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