[Diagnostic image (71). A woman with obesity, diabetes mellitus and use of corticosteroids. Mediastinal lipomatosis]. / Diagnose in beeld (71). Een vrouw met adipositas, diabetes mellitus en corticosteroïdgebruik. Mediastinale lipomatose.

In a 69-year-old obese woman on prednisone treatment for temporal arteritis a widened mediastinum on chest X-ray proved to be mediastinal lipomatosis on CT-scan.

Mechanical efficacy of the mobilising cervical support device (Mbrace).

This study evaluated the mechanical efficacy of a new "mobilising" cervical support device. This device has been developed in response to the requirements of whiplash patients to overcome the problems of heat and immobilisation which can occur in patients wearing conventional wrap-around cervical collars. All planes of cervical range of motion of 21 volunteer subjects without current or past cervical dysfunction were measured actively and passively under two conditions (no support and with cervical support) using the cervical range of motion (CROM) instrument. The results show that the mobilising cervical support device restricts hyperextension effectively while allowing substantial movement in other planes of motion (flexion, rotation and lateral bending). This potential mobility keeps nearly all muscles in the neck fit and problems of muscle atrophy, weakness and contraction, which can occur in patients using conventional cervical wrap around collars, can be avoided. Regarding mechanical efficacy, the mobilising cervical support device can be useful in the (early) mobilisation phase in patients needing gentle neck support after a soft tissue hyperextension or whiplash injury.

Radiologic prevalence of advanced lateral C1-C2 osteoarthritis.

STUDY DESIGN: The lateral C1-C2 (atlantoaxial) joints were evaluated retrospectively in 355 patients referred for radiographs of the paranasal sinuses. OBJECTIVES: To determine the radiologic prevalence of advanced lateral atlantoaxial osteoarthritis. SUMMARY OF BACKGROUND DATA: Previous studies have shown a relation between atlantoaxial osteoarthritis and referred pain in the suboccipital region. However, the radiologic prevalence of this degenerative disorder is unknown. METHODS: Five hundred radiographs of the paranasal sinuses were evaluated retrospectively. Both lateral atlantoaxial joints were clearly visible on occipitofrontal projections in 355 examinations. Each lateral atlantoaxial joint was considered severely degenerated when advanced narrowing or obliteration of the joint space, subchondral sclerosis, and/or osteophytosis were present. RESULTS: Atlantoaxial osteoarthritis was found in 4.8% of the patients. The radiologic prevalence of advanced degenerative changes at the lateral atlantoaxial joint(s) was found to increase with age, ranging from 5.4% in the sixth decade to 18.2% in the ninth decade of life. CONCLUSION: Because advanced degenerative changes at the lateral atlantoaxial joints can cause suboccipital neck pain, these findings should be included in the differential diagnosis in older patients with this symptom.

MRI of atlanto-odontoid osteoarthritis.

We present the MRI appearances of advanced degenerative changes at the atlanto-odontoid (AO) joint. Changes including obliteration of the joint space, subchondral sclerosis and osteophytosis were clearly depicted on fast gradient-echo T1-weighted MRI images. Recognition of these changes may be helpful in the diagnosis in patients with suboccipital pain.

Relationship between atlanto-odontoid osteoarthritis and idiopathic suboccipital neck pain.

We discuss the relationship of atlanto-odontoid (AO) (anterior C1-C2 joint) osteoarthritis to suboccipital pain. A questionnaire regarding suboccipital neck pain was presented to 210 consecutive patients undergoing computed tomography (CT) of the brain or sinuses for a variety of indications. In all patients the AO joint and the lateral scout image of the cervical spine were studied. In 104 (49%) degenerative changes were seen at the AO joint. There were 89 patients (42%) who reported pain in the suboccipital region, although this was not the reason for CT in any patient. Statistical analysis of the prevalence of suboccipital neck pain in all patients showed the presence of AO osteoarthritis seen on CT to be associated with occurrence of these symptoms. This association remained significant in the same study population after excluding patients with a history of rheumatoid arthritis, migraine, stress and neck trauma and patients with signs of degenerative changes of C2-C7 on the computed lateral scout image.

Association of transverse ligament calcification with anterior atlanto-odontoid osteoarthritis: CT findings.

The craniocervical junction was assessed in 700 consecutive unselected patients undergoing CT of the brain or paranasal sinuses, to investigate whether transverse ligament calcification was associated with advanced degenerative changes at the anterior atlanto-odontoid (AO) joint. Calcific deposits within the transverse ligament were seen in 40 patients (5.7%). The prevalence of this condition increased with age. Advanced degenerative changes (marked osteophytes and obliteration of the joint space) at the anterior AO joint were significantly more frequent in patients with transverse ligament calcification than in age-matched controls. We conclude that transverse ligament calcification is seen frequently in the elderly and very frequently with advanced degenerative changes at the anterior AO joint.

Vacuum phenomenon in osteoarthritis of the atlanto-odontoid joint: CT findings.

Out of 620 consecutive examinations of the atlanto-odontoid joint in patients referred for computed tomography (CT) of the brain or paranasal sinuses, gas collection within the atlanto-odontoid joint was observed in 12 (1.9%). Degenerative abnormalities at the atlanto-odontoid joint were significantly more frequent in patients with a gas-induced vacuum phenomenon than in an age-matched control group. The CT findings and association of the vacuum phenomenon with osteoarthritis of the atlanto-odontoid joint are discussed.

Intra-arterial digital subtraction angiography with isotonic dimeric (iodixanol) and monomeric (iohexol) nonionic contrast media: radiographic, clinical and neurophysiological evaluation.

Monomeric (iohexol 300 mg I/ml) and dimeric (iodixanol 270 mg I/ml) nonionic contrast media were compared in a double-blind, randomised, parallel group trial. Safety and efficacy of the media in intra-arterial cerebral digital subtraction angiography were evaluated by assessing adverse events, discomfort, EEG, heart rate and quality of radiodiagnostic information. Seventy-six patients underwent selective injection of the carotid and/or vertebral arteries. Both contrast media were well tolerated. No serious adverse events occurred. No effects on heart rate and EEG were evident. The arteriograms were of high quality and overall diagnostic information was optimal in 94% of the examinations. No clinically important differences between the two contrast media were found.

Atlanto-odontoid osteoarthritis. Appearance and prevalence at computed tomography.

STUDY DESIGN: In this prospective study, the authors evaluated the atlanto-odontoid (AO) joint in 500 consecutive patients who underwent computed tomographies (CTs) of the brain or paranasal sinuses. OBJECTIVES: The objective of the study was to determine age specificity of various morphologic abnormalities related to osteoarthritis at the AO joint in patients referred for CT primarily to exclude brain or sinus abnormalities. SUMMARY OF BACKGROUND DATA: In all patients, at least two axial slices through the AO joint were evaluated by two authors, and agreement was reached by consensus. METHODS: Abnormal morphology was categorized into three groups: (1) osteophytosis; (2) obliteration of the joint space; and (3) transverse ligament calcification. RESULTS: In a significant percentage of older individuals, some form of degenerative disease is present. These changes show a roughly linear progression with advancing age. CONCLUSION: Morphologic changes related to AO osteoarthritis are frequent coincidental findings in patients referred for CT examination of the brain or paranasal sinuses. Awareness of the appearance and prevalence of degenerative changes in the AO joint on CT is important because reports in the literature and earlier findings of the authors indicate that these changes can be a source of suboccipital headache.

Atlantoodontoid osteoarthritis: comparison of lateral cervical projection and CT.

The purpose of this study was to assess the accuracy of lateral cervical spine radiography in the detection of degenerative atlantoodontoid (AO) osteoarthritis, with CT as gold standard. In 50 patients, lateral radiographs and CT of the AO joint were blindly and independently graded by two radiologists: 0 = normal, 1 = mild degenerative disease, 2 = severe degenerative disease. Radiography was most accurate in distinguishing absent or mild disease from severe disease (83% sensitivity, 84% specificity). Sensitivity in distinguishing absent disease from mild or severe disease was 87%. Specificity, however, was low (52%), due to overestimation of the degenerative involvement on radiography. It is concluded that conventional radiography is a useful technique in screening for AO osteoarthritis, especially in severely degenerated joints. However, CT provides the best radiographic detail necessary for accurate diagnosis.