Objective Indirect Assessment of Transverse Ligament Competence Using Quantitative Analysis of 3-Dimensional Segmented Flexion-Extension Computed Tomography Scan

2019 
Abstract Objective Assessment of transverse ligament (TL) competence in patients with suspected atlantoaxial instability is performed via indirect radiograph measurements or direct TL visualization on magnetic resonance imaging (MRI). Interpretation of these images can be limited by unique patient anatomy or imaging technique variability. We report a novel technique for evaluating TL competence using flexion-extension computed tomography (feCT) with three-dimensional (3D) segmentation and quantitative analysis. Methods feCT scans of 11 patients were segmented to create 3D surface models. 6 patients with atlantoaxial pathology were evaluated for possible instability based on clinical examination and imaging findings. The other 5 had no clinical or imaging evidence of atlantoaxial injury. Dynamic atlantodental interval (ADI) was calculated using point-to-point voxel changes between flexion and extension 3D models. Magnitude and direction of ADI changes were quantified and compared with available cervical spine flexion-extension radiograph and/or MRI findings. Results In the 5 patients without evidence of atlantoaxial injury, 94.3% of ADI vector changes were Conclusions 3D segmentation and quantitative analysis of feCT allows objective indirect assessment of TL integrity. Results are consistent with MRI findings and offer additional biomechanical information regarding the direction and distribution of atlantoaxial motion.
    • Correction
    • Source
    • Cite
    • Save
    • Machine Reading By IdeaReader
    14
    References
    0
    Citations
    NaN
    KQI
    []