Name : Maryam
Resident : ----------------
Gender : Male
Age : 32
Head & Neck Imaging
A 32 year old man with recent onset of myelopathy
Imaging Procedures and Findings
A 32 year old man with a past history of swelling in joints, morning pain & stiffness, presented with progressive radiculopathy in cervical spine & myelopathy. Performed MRI revealed diffuse discovertebral osteodegenerative changes especially from C2 to C6 levels associated with basilar invagination , atlanto-axial subluxation & erosion of odontoid process caused by a mass like lesion with predominantly low intensity on T1 & T2w (pannus). You can see cord compression, also high signal intensity in cervical cord related to myelomalacia
Cervical spine involves in approximately 60% of RA patients. C1-C2 instability is noted in 33% of all RA patients but in 5% of all RA cases AAS is seen. Using MRI on Tlw pannus is low signal intensity, mass-like lesion, also we can see erosions. On T2w pannus is heterogeneous signal intensity contained low signal areas may mimic pigmented villonodular synovitis (PVNS). Bone marrow edema& facet joint effusions are also common. Cord may be compressed by pannus. T1 with contrast is used in early diagnosis of RA because pannus enhances avidly.
Atlanto-axial subluxation, basilar invagination & myelomalacia (RA)
Diagnostic Imaging Spine, Ross and Moore et al. Fundamental of diagnostic radiology, William E. Brant, Clyde A. Helms.