CT angiographic evaluation of the V3 vertebral artery course in cases of occipitalized atlas, a study of 25 cases.

OBJECTIVES: To study the relationship of the 3rd segment of the vertebral artery to the posterior arch of the atlas in patients with occipitalized atlas, using CT angiography. METHODS: A retrospective study of 25 cases with complete or partially occipitalized atlas who underwent CT angiography evaluation. Fifty vertebral arteries were analyzed in relation to the respective/related half of the posterior arch of the atlas. RESULTS: Out of 50 vertebral arteries, 35 (70%) were anomalous; 31 (62%) traversed though bony canal between the fused occiput and atlas, and 4 (8%) coursed between C1 and C2 (C2 segmental type of vertebral artery). Except one, all anomalous vertebral arteries were associated with a fused corresponding side of posterior arch of atlas. CONCLUSION: The V3 portion of the vertebral artery assumes an anomalous course at the craniovertebral junction in most cases of occipitalized atlas, and this is strongly determined by the fusion status of the posterior arch of the atlas. Aberrations in its course are still seen despite expectations based on this fusion status. Preprocedural CT Angiography provides accurate information of its course to prevent iatrogenic VA injuries. ADVANCES IN KNOWLEDGE: CT Angiography should be performed before any procedures at the craniovertebral junction in cases of occipitalized atlas to prevent iatrogenic, potentially catastrophic injuries to vertebral artery due to its anomalous course in most of these cases. There are very few such studies in the literature, none in radiology literature. We also describe some rare cases, including a case never described in any literature.

Can Presurgical Ultrasound Predict Survival in Women With Ovarian Masses?

PURPOSE: This study aimed to determine the ability of ultrasound to predict survival and detect more aggressive tumors in women with ovarian masses. MATERIALS AND METHODS: Institutional review board approval was obtained. A total of 167 patients who presented with adnexal mass/masses were included. These were documented as benign or malignant on ultrasound. Age, date of diagnosis and date of death, type of tumor, and tumor marker cancer antigen 125 (CA-125) values were recorded. A CA-125 value of less than 35 U/mL was considered normal. All cases underwent surgery. Pathologic findings were considered as reference standard. The 2 × 2 cross-tabulations were used to correlate dichotomized CA-125, US diagnosis (benign vs malignant), and pathologic status. Difference of distributions was tested using the Wilcoxon rank sum test, and their association was tested using the Fisher exact test. All tests were 2-sided, and P values of 0.05 or less were considered statistically significant. Kaplan-Meir curves were generated to estimate survival. RESULTS: There was a statistically significant difference in patients with benign versus malignant tumors based on pathology (P < 0.0001) and ultrasound (P < 0.0003). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound were 55%, 86%, 90% and 46%, and 81%. Patients diagnosed as having malignant tumors based on ultrasound had statistically significant worse overall survival. Probability of survival based on pathologic diagnosis of malignancy was statistically significant at P < 0.0003; based on ultrasound, P < 0.0001; and based on CA-125, P < 0.041. CONCLUSION: Patients who had ultrasound-based prediction of ovarian malignancy had overall worse survival probability (P < 0.0001) compared with CA-125- or pathology-based prediction.

Anomalous vertebral arteries in Klippel-Feil syndrome with occipitalized atlas: CT angiography.

Klippel-Feil syndrome is an uncommon anomaly that may be asymptomatic. Early clinical signs such as restricted neck motion or short neck can be subtle and incorrectly treated as spasms. High incidence of associated craniovertebral junction (CVJ) anomalies such as occipitalized atlas predisposes them to serious neurologic complications requiring invasive procedures and surgeries. However, these often have anomalous vertebral artery course which is more prone to injury during CVJ procedures, and also sparsely known in radiology literature. We demonstrate the importance of computed tomography angiography in preprocedural planning to avoid catastrophic injury to anomalous vertebral artery at CVJ in such case.

C2 segmental type of vertebral artery on the unfused side of partially occipitalized atlas.

Patients with craniovertebral junction anomalies are more likely to undergo craniovertebral junction procedures because of neurologic complications. Vertebral arteries (VAs) are more prone to injury in these cases because of an often anomalous course, with potentially disabling or grave sequel. In our patient with partially occipitalized atlas, CT angiogram revealed that 1 of the VAs passed through the bony canal in the occipitalized and/or fused bone, whereas the VA on unfused side was also unexpectedly anomalous and of C2 segmental type. To the best of our knowledge, such anomaly has never been reported in studies of patients with occipitalized atlas in the literature.