Study design: Comparison of findings in plain radiography and conventional tomography with findings in plain radiography and magnetic resonance imaging of the upper cervical spine in consecutive patients with rheumatoid arthritis and with known or suspected abnormalities of the cervical 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 rheumatoid arthritis.
Summary of background data: With the recent advances in magnetic resonance imaging technology and the proliferation of magnetic resonance imaging techniques for specific clinical conditions.
Methods: Twenty-eight patients with rheumatoid arthritis and with known or suspected abnormalities of the cervical spine underwent a clinical neurologic examination; plain radiography, including full flexion lateral radiography; anteroposterior and lateral tomography at C1-C2; and magnetic resonance imaging at the same level in neutral position and in flexion. Two radiologists evaluated one image set consisting of plain radiography and conventional tomographic images and another image set consisting of plain radiography and magnetic resonance images, for each patient.
Results: Compared with conventional tomography and plain radiography, magnetic resonance imaging and plain radiography showed cystic lesions and erosions of the odontoid process and vertical atlantoaxial subluxation more often, showed anterior subluxation as often, and showed lateral atlantoaxial subluxation less often.
Conclusion: Magnetic resonance imaging produces sufficiently 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.