Name of the Patient : Abc Xyz Tlmn / F / 15 yrs.
Referred by : Dr. Abc Xyz. Shah / Dr. Abc Xyzsrani
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
M.R.I of the cervical spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.
There is basilar invagination with the tip of the odontoid process displacing and compressing the cervico-medullary junction. The cervico-medullary junction and upper cord (C1 and C2 levels) shows a hyperintense signal on the T2 Weighted and Fast Scan (T2 *) images. This is isointense to normal cord on the T1 Weighted images and is suggestive of cord edema/ischemia/myelitis.
There is replacement of the normal marrow of the C2 odontoid process and vertebral body by hypointense areas on the T1 Weighted images. The anterior arch and the lateral masses of the C1 vertebra, occipital condyles and the tip of the clivus also show similar signal change. These are seen to turn heterogeneously hyperintense on the T2 Weighted and Fast Scan (T2 *) images. There is pre and paravertebral soft tissue extension from the level of the clivus to the C3 vertebral level, more so on the right side. Anterior and right lateral epidural extension is seen over the C1 to the C2-C3 level. Extension is also noted between the occipital condyles and lateral masses of the C1 vertebra.
The C4-C5 and C5-C6 intervertebral discs show loss of water content.
The rest of the cervical vertebral bodies and the remaining intervertebral discs show normal signal intensity. The joints of Luschka are unremarkable.
Incidental note is made of enlarged lymph nodes in the deep cervical chain.
The MRI features are suggestive of :
1. Basilar invagination with the tip of the odontoid process displacing and compressing the cervico-medullary junction and upper cord with altered signal suggestive of edema/ischemia/myelitis.
2. A pathologic process involving the C1 and C2 vertebrae, occipital condyles and the tip of the clivus with extensions as described and is most probably a granulomatous infective process like tuberculosis. The possibility of this being a neoplastic process is less likely.