Magnetic resonance imaging of the ligaments of the craniocervical region at 3Tesla magnetic resonance unit: Quantitative and qualitative assessment

Abstract

Purpose: The assessment of the morphology and di-mensions of the craniocervical ligaments using a 3 Tesla (T) Magnetic Resonance (MR) scanner, the cor-relatation of our results with those from cadaveric and other MR studies and the detection of the most appropriate sequence for the best imaging of the cra-niovertebral junction ligaments. Methods: 58 healthy volunteers (mean age 45 years) underwent a Magnetic Resonance Imaging (MRI) of the cervical spine at 3T MR unit. The MRI protocol included axial, coronal and sagittal Proton-Density (PD) sequences and sagit-tal T1 Fluid Attenuated Inversion Recovery (FLAIR) and T2 sequences. The images were evaluated by two radiologists and the posterior atlantoocipital ligament, the anterior atlantoocipital ligament, the transverse ligament and the apical ligament were anatomically detected, described and measured. Results: The tran-sverse ligament was identified at 93.1%, the apical ligament was identified at 60.34%, the posterior at-lantooccipital membrane was identified at 94.8% and the anterior atlantooccipital membrane was identified at 96.5% of the cases. All ligaments appeared with low signal intensity, except the anterior atlantooc-cipital ligament which appeared with intermediate signal intensity. Their length, width and thickness were measured and, in general, correlated well with other anatomic and MR studies. Conclusion: Reliable assessment of the morphology and signal intensity of the craniocervical ligaments can be achieved with PD sequence at 3T MR imaging. The sagittal plane pro-vides better delineation of the craniocervical (CC) ligaments but the axial and coronal planes are of paramount importance in the assessment of the trans-verse and apical ligaments.