ABSTRACT
This article critically reviews the current state of knowledge on the quality of animal-source foods according to animal production and food processing conditions, including consumer expectations-behaviours and the effects of consumption of animal-source foods on human health. Quality has been defined through seven core attributes: safety, commercial, sensory, nutritional, technological, convenience, and image. Image covers ethical, cultural and environmental dimensions associated with the origin of the food and the way it is produced and processed. This framework enabled to highlight the priorities given to the different quality attributes. It also helped to identify potential antagonisms and synergies among quality attributes, between production and processing stages, and among stakeholders. Primacy is essentially given to commercial quality attributes, especially for standard commodity animal-source foods. This primacy has strongly influenced genetic selection and farming practices in all livestock commodity chains and enabled substantial quantitative gains, although at the expense of other quality traits. Focal issues are the destructuration of chicken muscle that compromises sensory, nutritional and image quality attributes, and the fate of males in the egg and dairy sectors, which have heavily specialised their animals. Quality can be gained but can also be lost throughout the farm-to-fork continuum. Our review highlights critical factors and periods throughout animal production and food processing routes, such as on-farm practices, notably animal feeding, preslaughter and slaughter phases, food processing techniques, and food formulation. It also reveals on-farm and processing factors that create antagonisms among quality attributes, such as the castration of male pigs, the substitution of marine-source feed by plant-based feed in fish, and the use of sodium nitrite in meat processing. These antagonisms require scientific data to identify trade-offs among quality attributes and/or solutions to help overcome these tensions. However, there are also food products that value synergies between quality attributes and between production and processing phases, particularly Geographical Indications, such as for cheese and dry-cured ham. Human epidemiological studies have found associations between consumption of animal-source foods and increased or decreased risk for chronic non-communicable diseases. These associations have informed public health recommendations. However, they have not yet considered animal production and food processing conditions. A concerted and collaborative effort is needed from scientists working in animal science, food process engineering, consumer science, human nutrition and epidemiology in order to address this research gap. Avenues for research and main options for policy action are discussed.
Subject(s)
Animal Feed , Meat , Animals , Livestock , Male , Nutritional Status , SwineABSTRACT
BACKGROUND AND PURPOSE: Flow diverter-induced hemodynamic change plays an important role in the mechanism of intracranial aneurysm occlusion. Our aim was to explore the relationship between aneurysm features and flow-diverter treatment of unruptured sidewall intracranial aneurysms. MATERIALS AND METHODS: MR imaging, 4D phase-contrast, was prospectively performed before flow diverter implantation in each patient with unruptured intracranial aneurysm. Two postprocedure follow-ups were scheduled at 6 and 12 months. Responses were grouped according to whether the aneurysms were occluded or remnant. Preprocedural aneurysm geometries and ostium hemodynamics in 38 patients were compared between the 2 groups at 6 and 12 months. Receiver operating characteristic curve analyses were performed for significant geometric and hemodynamic continuous parameters. RESULTS: After the 6-month assessment, 21 of 41 intracranial aneurysms were occluded, and 9 additional aneurysms were occluded at 12 months. Geometrically, the ostium maximum diameter was significantly larger in the remnant group at 6 and 12 months (both P < .001). Hemodynamically, the proximal inflow zone was more frequently observed in the remnant group at 6 months. Several preprocedural ostium hemodynamic parameters were significantly higher in the remnant group. As a prediction for occlusion, the areas under the curve of the ostium maximum diameter (for 6 and 12 months), systolic inflow rate ratio (for 6 months), and systolic inflow area (for 12 months) reached 0.843, 0.883, 0.855, and 0.860, respectively. CONCLUSIONS: Intracranial aneurysms with a large ostium and strong ostium inflow may need a longer time for occlusion. Preprocedural 4D flow MR imaging can well illustrate ostium hemodynamics and characterize aneurysm treatment responses.
Subject(s)
Intracranial Aneurysm/pathology , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/surgery , Adult , Aged , Aged, 80 and over , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Endovascular Procedures/methods , Female , Hemodynamics/physiology , Humans , Magnetic Resonance Imaging/methods , Male , Middle AgedABSTRACT
BACKGROUND AND PURPOSE: Flow-diverter stents are widely used for the treatment of wide-neck intracranial aneurysms. Various parameters may influence intracranial aneurysm thrombosis, including the flow reduction induced by flow-diverter stent implantation, which is assumed to play a leading role. However, its actual impact remains unclear due to the lack of detailed intra-aneurysmal flow measurements. This study aimed to clarify this relationship by quantitatively measuring the intra-aneurysmal flow using 4D phase-contrast MR imaging. MATERIALS AND METHODS: We acquired prospective pre- and post-stent implantation 4D phase-contrast MR imaging data of a consecutive series of 23 patients treated with flow-diverter stents. Velocity field data were combined with the intraprocedural 3D angiogram vessel geometries for precise intracranial aneurysm extraction and partial volume correction. Intra-aneurysmal hemodynamic modifications were compared with occlusion outcomes at 6 and 12 months. RESULTS: The averaged velocities at systole were lower after flow-diverter stent implantation for all patients and ranged from 21.7 ± 7.1 cm/s before to 7.2 ± 2.9 cm/s after stent placement. The velocity reduction was more important for the group of patients with aneurysm thrombosis at 6 months (68.8%) and decreased gradually from 66.2% to 55% for 12-month thrombosis and no thrombosis, respectively (P = .08). CONCLUSIONS: We propose an innovative approach to measure intracranial flow changes after flow-diverter stent implantation. We identified a trend between flow reduction and thrombosis outcome that brings a new insight into current understanding of the flow-diversion treatment response.
Subject(s)
Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/surgery , Magnetic Resonance Imaging/methods , Neuroimaging/methods , Neurosurgical Procedures/methods , Adult , Endovascular Procedures/methods , Female , Hemodynamics/physiology , Humans , Male , Middle Aged , Prospective Studies , StentsABSTRACT
Patient-specific inflow rates are rarely available for computational fluid dynamics (CFD) studies of intracranial aneurysms. Instead, inflow rates are often estimated from parent artery diameters via power laws, i.e. Qâ¯ââ¯Dn, reflecting adaptation of conduit arteries to demanded flow. The present study aimed to validate the accuracy of these power laws. Internal carotid artery (ICA) flow rates were measured from 25 ICA aneurysm patients via 2D phase contrast MRI. ICA diameters, derived from 3D segmentation of rotational angiograms, were used to estimate inflow rates via power laws from the aneurysm CFD literature assuming the same inlet wall shear stress (WSS) (nâ¯=â¯3), velocity (nâ¯=â¯2) or flow rate (nâ¯=â¯0) for all cases. To illustrate the potential impact of errors in flow rate estimates, pulsatile CFD was carried out for four cases having large errors for at least one power law. Flow rates estimated by nâ¯=â¯3 and nâ¯=â¯0 power laws had significant (pâ¯<â¯0.01) mean biases of -22% to +32%, respectively, but with individual errors ranging from -78% to +120%. The nâ¯=â¯2 power law had no significant bias, but had non-negligible individual errors of -58% to +71%. CFD showed similarly large errors for time-averaged sac WSS; however, these were reduced after normalizing by parent artery WSS. High frequency WSS fluctuations, evident in 2/4 aneurysms, were also sensitive to inflow rate errors. Care should therefore be exercised in the interpretation of aneurysm CFD studies that rely on power law estimates of inflow rates, especially if absolute (vs. normalized) WSS, or WSS instabilities, are of interest.
Subject(s)
Carotid Artery, Internal/physiology , Intracranial Aneurysm/physiopathology , Adult , Aged , Angiography , Carotid Artery, Internal/diagnostic imaging , Female , Humans , Hydrodynamics , Intracranial Aneurysm/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Models, Cardiovascular , Stress, MechanicalABSTRACT
OBJECTIVE: Vessel lumen calibres and flow rates are thought to be related by mathematical power laws, reflecting the optimization of cardiac versus metabolic work. While these laws have been confirmed indirectly via measurement of branch calibres, there is little data confirming power law relationships of flow distribution to branch calibres at individual bifurcations. APPROACH: Flow rates and diameters of parent and daughter vessels of the internal carotid artery terminal bifurcation were determined, via robust and automated methods, from 4D phase-contrast magnetic resonance imaging and 3D rotational angiography of 31 patients. MAIN RESULTS: Junction exponents were 2.06 ± 0.44 for relating parent to daughter branch diameters (geometrical exponent), and 2.45 ± 0.75 for relating daughter branch diameters to their flow division (flow split exponent). These exponents were not significantly different, but showed large inter- and intra-individual variations, and with confidence intervals excluding the theoretical optimum of 3. Power law fits of flow split versus diameter ratio and pooled flow rates versus diameters showed exponents of 2.17 and 1.96, respectively. A significant negative correlation was found between age and the geometrical exponent (r = -0.55, p = 0.003) but not the flow split exponent. We also found a dependence of our results on how lumen diameter is measured, possibly explaining some of the variability in the literature. SIGNIFICANCE: Our study confirms that, on average, division of flow to the middle and anterior cerebral arteries is related to these vessels' relative calibres via a power law, but it is closer to a square law than a cube law as commonly assumed.
Subject(s)
Blood Circulation , Carotid Artery, Internal/physiology , Adult , Aged , Carotid Artery, Internal/anatomy & histology , Carotid Artery, Internal/diagnostic imaging , Female , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Middle AgedABSTRACT
The challenge of one-dimensional systems is to understand their physics beyond the level of known elementary excitations. By high-resolution neutron spectroscopy in a quantum spin-ladder material, we probe the leading multiparticle excitation by characterizing the two-magnon bound state at zero field. By applying high magnetic fields, we create and select the singlet (longitudinal) and triplet (transverse) excitations of the fully spin-polarized ladder, which have not been observed previously and are close analogs of the modes anticipated in a polarized Haldane chain. Theoretical modeling of the dynamical response demonstrates our complete quantitative understanding of these states.
ABSTRACT
BACKGROUND AND PURPOSE: Intracranial stents have become extremely important in the endovascular management of complex intracranial aneurysms. Sizing and landing zone predictions are still very challenging steps in the procedure. Virtual stent deployment may help therapeutic planning, device choice, and hemodynamic simulations. We aimed to assess the predictability of our recently developed virtual deployment model by comparing in vivo and virtual stents implanted in a consecutive series of patients presenting with intracranial aneurysms. MATERIALS AND METHODS: Virtual stents were implanted in patient-specific geometries of intracranial aneurysms treated with the Pipeline Embolization Device. The length and cross-section of virtual and real stents measured with conebeam CT were compared. The influence of vessel geometry modifications occurring during the intervention was analyzed. RESULTS: The virtual deployment based on pre- and poststent implantation 3D rotational angiography overestimated (underestimated) the device length by 13% ± 11% (-9% ± 5%). These differences were highly correlated (R2 = 0.67) with the virtual-versus-real stent radius differences of -6% ± 7% (5% ± 4%) for predictions based on pre- and poststent implantation 3D rotational angiography. These mismatches were due principally to implantation concerns and vessel-shape modifications. CONCLUSIONS: The recently proposed geometric model was shown to predict accurately the deployment of Pipeline Embolization Devices when the stent radius was well-assessed. However, unpredictable delivery manipulations and variations of vessel geometry occurring during the intervention might impact the stent implantation.
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BACKGROUND AND PURPOSE: Digital subtraction angiography is the gold standard vascular imaging and it is used for all endovascular treatment of intracranial anerysms. Optical flow imaging has been described as a potential method to evaluate cerebral hemodynamics through DSA. In this study, we aimed to compare the flow patterns measured during angiography, by using an optical flow method, with those measured by using computational fluid dynamics in intracranial aneurysms. MATERIALS AND METHODS: A consecutive series of 21 patients harboring unruptured saccular intracranial aneurysms who underwent diagnostic angiography before treatment was considered. High-frame-rate digital subtraction angiography was performed to obtain an intra-aneurysmal velocity field by following the cardiac-modulated contrast wave through the vascular structures by using optical flow principles. Additionally, computational fluid dynamics modeling was performed for every case by using patient-specific inlet-boundary conditions measured with the optical flow method from both DSA and 3D rotational angiography datasets. Three independent observers compared qualitatively both the inflow direction and the apparent recirculation in regular DSA, optical flow images, and computational fluid dynamics flow patterns for each patient; κ statistics were estimated. RESULTS: We included 21 patients. In 14 of these 21, the flow patterns were conclusive and matching between the optical flow images and computational fluid dynamics within the same projection view (κ = .91). However, in only 8 of these 14 patients the optical flow images were conclusive and matching regular DSA images (observer κ = 0.87). In 7 of the 21 patients, the flow patterns in the optical flow images were inconclusive, possibly due to improper projection angles. CONCLUSIONS: The DSA-based optical flow technique was considered qualitatively consistent with computational fluid dynamics outcomes in evaluating intra-aneurysmal inflow direction and apparent recirculation. Moreover, the optical flow technique may provide the premises for new solutions for improving the visibility of flow patterns when contrast motion in DSA is not apparent. This technique is a diagnostic method to evaluate intra-aneurysmal flow patterns and could be used in the future for validation and patient evaluation.
Subject(s)
Angiography, Digital Subtraction/methods , Hemodynamics/physiology , Hydrodynamics , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/physiopathology , Mathematical Computing , Aged , Cerebral Angiography/methods , Female , Humans , Male , Middle Aged , Sensitivity and Specificity , Tomography, X-Ray Computed/methodsSubject(s)
Discitis/microbiology , Endocarditis, Bacterial/microbiology , Neisseria sicca/isolation & purification , Neisseriaceae Infections/microbiology , Thoracic Vertebrae/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Aortic Valve/microbiology , Ceftriaxone/therapeutic use , Ciprofloxacin/therapeutic use , Discitis/drug therapy , Endocarditis, Bacterial/drug therapy , Humans , Intervertebral Disc Degeneration/complications , Male , Neisseria sicca/enzymology , Neisseriaceae Infections/drug therapy , Penicillinase/metabolismABSTRACT
Inelastic neutron scattering is used to measure the spin excitation spectrum of the Heisenberg S=1/2 ladder material (C7H10N)2CuBr4 in its entirety, both in the gapped spin liquid and the magnetic field-induced Tomonaga-Luttinger spin liquid regimes. A fundamental change of the spin dynamics is observed between these two regimes. Density matrix renormalization group calculations quantitatively reproduce and help understand the observed commensurate and incommensurate excitations. The results validate long-standing quantum field-theoretical predictions but also test the limits of that approach.
Subject(s)
Magnetic Fields , Quantum Theory , Alkanes/chemistry , Bromides/chemistry , Copper/chemistryABSTRACT
Magnetic insulators have proven to be usable as quantum simulators for itinerant interacting quantum systems. In particular the compound (C(5)H(12)N)(2)CuBr(4) (for short: (Hpip)(2)CuBr(4)) was shown to be a remarkable realization of a Tomonaga-Luttinger liquid (TLL) and allowed us to quantitatively test the TLL theory. Substitution weakly disorders this class of compounds and thus allows us to use them to tackle questions pertaining to the effect of disorder in TLL as well, such as that of the formation of the Bose glass. In this paper we present, as a first step in this direction, a study of the properties of the related (Hpip)(2)CuCl(4) compound. We determine the exchange couplings and compute the temperature and magnetic field dependence of the specific heat, using a finite temperature density matrix renormalization group procedure. Comparison with the measured specific heat at zero magnetic field confirms the exchange parameters and Hamiltonian for the (Hpip)(2)CuCl(4) compound, giving the basis needed to begin studying the disorder effects.
Subject(s)
Models, Chemical , Models, Molecular , Quantum Theory , Solutions/chemistry , Computer Simulation , Spin LabelsABSTRACT
The strong-leg S=1/2 Heisenberg spin ladder system (C(7)H(10)N)(2)CuBr(4) is investigated using density matrix renormalization group calculations, inelastic neutron scattering, and bulk magnetothermodynamic measurements. Measurements showed qualitative differences compared to the strong-rung case. A long-lived two-triplon bound state is confirmed to persist across most of the Brillouin zone in a zero field. In applied fields, in the Tomonaga-Luttinger spin-liquid phase, elementary excitations are attractive, rather than repulsive. In the presence of weak interladder interactions, the strong-leg system is considerably more prone to three-dimensional ordering.
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BACKGROUND AND PURPOSE: Individual rupture risk assessment of intracranial aneurysms is a major issue in the clinical management of asymptomatic aneurysms. Aneurysm rupture occurs when wall tension exceeds the strength limit of the wall tissue. At present, aneurysmal wall mechanics are poorly understood and thus, risk assessment involving mechanical properties is inexistent. Aneurysm computational hemodynamics studies make the assumption of rigid walls, an arguable simplification. We therefore aim to assess mechanical properties of ruptured and unruptured intracranial aneurysms in order to provide the foundation for future patient-specific aneurysmal risk assessment. This work also challenges some of the currently held hypotheses in computational flow hemodynamics research. METHODS: A specific conservation protocol was applied to aneurysmal tissues following clipping and resection in order to preserve their mechanical properties. Sixteen intracranial aneurysms (11 female, 5 male) underwent mechanical uniaxial stress tests under physiological conditions, temperature, and saline isotonic solution. These represented 11 unruptured and 5 ruptured aneurysms. Stress/strain curves were then obtained for each sample, and a fitting algorithm was applied following a 3-parameter (C(10), C(01), C(11)) Mooney-Rivlin hyperelastic model. Each aneurysm was classified according to its biomechanical properties and (un)rupture status. RESULTS: Tissue testing demonstrated three main tissue classes: Soft, Rigid, and Intermediate. All unruptured aneurysms presented a more Rigid tissue than ruptured or pre-ruptured aneurysms within each gender subgroup. Wall thickness was not correlated to aneurysmal status (ruptured/unruptured). An Intermediate subgroup of unruptured aneurysms with softer tissue characteristic was identified and correlated with multiple documented risk factors of rupture. CONCLUSION: There is a significant modification in biomechanical properties between ruptured aneurysm, presenting a soft tissue and unruptured aneurysms, presenting a rigid material. This finding strongly supports the idea that a biomechanical risk factor based assessment should be utilized in the to improve the therapeutic decision making.
Subject(s)
Aneurysm, Ruptured , Hemodynamics , Intracranial Aneurysm , Models, Cardiovascular , Stress, Physiological , Aneurysm, Ruptured/pathology , Aneurysm, Ruptured/physiopathology , Aneurysm, Ruptured/surgery , Female , Humans , Intracranial Aneurysm/pathology , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/surgery , Male , Risk AssessmentSubject(s)
Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Lymphoma, B-Cell/diagnosis , Lymphoma, B-Cell/pathology , Aged , Brain/diagnostic imaging , Brain/pathology , Brain Neoplasms/diagnostic imaging , Female , Humans , Lymphoma, B-Cell/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
The phase diagram in temperature and magnetic field of the metal-organic, two-leg, spin-ladder compound (C5H12N)2CuBr4 is studied by measurements of the specific heat and the magnetocaloric effect. We demonstrate the presence of an extended spin Luttinger-liquid phase between two field-induced quantum critical points and over a broad range of temperature. Based on an ideal spin-ladder Hamiltonian, comprehensive numerical modeling of the ladder specific heat yields excellent quantitative agreement with the experimental data across the entire phase diagram.
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We present a 14N nuclear magnetic resonance study of a single crystal of CuBr4(C5H12N)2 (BPCB) consisting of weakly coupled spin-1/2 Heisenberg antiferromagnetic ladders. Treating ladders in the gapless phase as Luttinger liquids, we are able to fully account for (i) the magnetic field dependence of the nuclear spin-lattice relaxation rate T1(-1) at 250 mK and for (ii) the phase transition to a 3D ordered phase occurring below 110 mK due to weak interladder exchange coupling. BPCB is thus an excellent model system where the possibility to control Luttinger liquid parameters in a continuous manner is demonstrated and the Luttinger liquid model tested in detail over the whole fermion band.
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Symptoms of chronic myelopathy in cases of paraspinal arteriovenous malformations are most often related to perimedullary venous drainage. Here, we report on three cases of such malformations that have unique epidural venous drainage. These thoracolumbar lesions manifested as isolated back pain (in two cases) and S1 lumboradicular pain (in one case). MRI presented evidence to suggest a diagnosis of these rare conditions, based on signs of vertebral erosion, signal loss (flow void) on T1- and T2-weighted imaging, and partial enhancement after gadolinium injection, with no signs of congestive myelopathy. Spinal angiography confirmed the presence of a paraspinal fistula and, at the same time, allowed treatment by intra-arterial onyx injection.
Subject(s)
Arteriovenous Fistula/diagnostic imaging , Central Nervous System Vascular Malformations/diagnostic imaging , Spinal Cord/blood supply , Arteriovenous Fistula/pathology , Arteriovenous Fistula/physiopathology , Central Nervous System Vascular Malformations/pathology , Central Nervous System Vascular Malformations/physiopathology , Humans , Magnetic Resonance Imaging , Middle Aged , RadiographyABSTRACT
BACKGROUND: Sublingual immunotherapy (SLIT) has been demonstrated to be a viable alternative to injection immunotherapy. Administration of high doses of allergens to ensure efficacy has been shown to be well tolerated. The aim of the present study was the first step to address the issue of fast-induction regimens using various induction SLIT regimens in paediatric and adult patients. METHODS: Sixty-four patients (age range 5-46 years) with grass pollen rhinoconjunctivitis were enrolled in an 8-month double-blind, placebo-controlled trial of SLIT. Sixty-three patients were randomized to four groups and evaluated at the end of the study. One group received placebo (n = 16) and the other three groups (n = 47) received five grass pollen extracts according to three different induction regimens: regimen 1 starting with 3 IR tablets (n = 15), regimen 2 starting with 10 IR (n = 16) and regimen 3 starting with 30 IR (n = 16). The maintenance phase was made with sublingual-swallow drops at the same concentration of 300 IR/ml for all the patients. Adverse events were recorded on diary cards. RESULTS: During induction phase, 25/47 patients in the SLIT groups had adverse reactions in comparison to 2/16 patients in the placebo group (p < 0.05). The rate of adverse reactions was 33.3% (11.8-61.6) (95% CI) for regimen 1, 31.3% (11.0-58.7) for regimen 2, 43.8% (19.8-70.1) for regimen 3 and 12.5% (1.6-38.3) for placebo. Fifty-seven reactions were local reactions involving the oral region (54 SLIT, 3 placebo) and 13 were systemic reactions (all in the SLIT groups). 11/13 reactions were mild (gastrointestinal disorders, rhinoconjunctivitis), 1/13 consisted of moderate asthma and 1/13 consisted of severe abdominal pain. No urticaria, angioedema or life-threatening events were observed. CONCLUSIONS: These preliminary data showed that various induction regimens for SLIT are generally well tolerated and could allow a fast build-up phase of SLIT.
Subject(s)
Desensitization, Immunologic/methods , Administration, Sublingual , Adolescent , Adult , Child , Child, Preschool , Cross Reactions/drug effects , Cross Reactions/immunology , Desensitization, Immunologic/adverse effects , Dose-Response Relationship, Drug , Drug Hypersensitivity/etiology , Female , Humans , Male , Middle Aged , Patient Compliance , Safety , Severity of Illness Index , Treatment OutcomeABSTRACT
We describe a previously unreported complication after anterior surgery of the cervical spine for melanoma. Ten days after the surgical procedure, a 51-year-old man presented a huge cystic cervical metastasis along the surgical route. The pathophysiology and the surgical risk of the procedure are discussed.
Subject(s)
Cervical Vertebrae/pathology , Melanoma/secondary , Neurosurgical Procedures/adverse effects , Spinal Neoplasms/pathology , Cervical Vertebrae/surgery , Combined Modality Therapy , Humans , Male , Melanoma/radiotherapy , Melanoma/surgery , Middle Aged , Spinal Neoplasms/radiotherapy , Spinal Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
This report describes three cases of symptomatic unilateral C1-C2 mass osteoarthritis. The patients were all female aged 67, 62 and 59 years. One patient had a history of rheumatoid arthritis. Unilateral occipital pain was the main symptom. Neuroradiological work-up included open mouth anteroposterior radiograph, flexion/extension lateral radiograph of the cervical spine, CT scan with coronal and sagittal reconstruction and MRI. Findings allowed differential diagnosis with tumoral or infectious disease of upper cervical spine and ruled out C1-C2 instability. CT scan and MRI permitted precise operative planning by determining the course of vertebral artery in the C1 and C2 vertebrae. Two patients were treated by CT scan guided steroid injection. The third patient was treated by C1-C2 arthodesis after failure of conservative treatment.