FUNCTIONAL TURBO SPIN-ECHO MAGNETIC-RESONANCE-IMAGING VERSUS TOMOGRAPHY FOR EVALUATING CERVICAL-SPINE INVOLVEMENT IN RHEUMATOID-ARTHRITIS

Study Design. Comparison of findings in plain radiography and conventi onal tomography with findings in plain radiography and magnetic resona nce imaging of the upper cervical spine in consecutive patients with r heumatoid arthritis and with known or suspected abnormalities of the c ervical spine. Objectives. To determine whether plain radiography and magnetic resonance imaging provide enough information to dispense with tomography in investigations of cervical spine involvement in rheumat oid arthritis. Summary of Background Data. With the recent advances in magnetic resonance imaging technology and the proliferation of magnet ic resonance imaging scanners, it is important to determine whether ma gnetic resonance imaging can replace existing imaging techniques for s pecific clinical conditions. Methods. Twenty-eight patients with rheum atoid arthritis and with known or suspected abnormalities of the cervi cal spine underwent a clinical neurologic examination; plain radiograp hy, including full flexion lateral radiography; anteroposterior and la teral tomography at C1-C2; and magnetic resonance imaging at the same level in neutral position and in flexion. Two radiologists evaluated o ne image set consisting of plain radiography and conventional tomograp hic images and another image set consisting of plain radiography and m agnetic resonance images, for each patient. Results. Compared with con ventional tomography and plain radiography, magnetic resonance imaging and plain radiography showed cystic lesions and erosions of the odont oid process and vertical atlantoaxial subluxation more often, showed a nterior subluxation as often, and showed lateral atlantoaxial subluxat ion less often. Conclusion. Magnetic resonance imaging produces suffic iently distinct images of destruction of the odontoid and subluxations for it to replace conventional tomography in investigations of upper cervical spine involvement in rheumatoid arthritis.