Apparent Diffusion Coefficient as an Indicator of Spinal Cord Compression Due to Anterior Atlanto-axial subluxation in Rheumatoid Arthritis Patients


The aim of this retrospective study was to evaluate the apparent diffusion coefficient (ADC) as a potential parameter of spinal cord damage in cervical spine instability at the atlanto-axial level in rheumatoid arthritis (RA) patients.


One hundred and six RA patients were included in the study. MRI examinations were performed with 1.5T scanner. The ADC was measured at six locations in the cervical spinal cord at the height of the first six cervical vertebrae (from C-1 to C-6). The ADC values were assessed in 2 groups: with and without anterior atlanto-axial subluxation (AAS) diagnosed on plain radiographs. Correlations between ADC values and radiographic measurements and RA activity indicators were evaluated.


The ADC values at C1 level (ADC1) was higher in the group with anterior AAS than in the group without AAS (p < 0.001). Statistically significant moderate positive correlation between ADC1 and anterior atlanto-axial diameter interval AADI (rho = 0.58; p < 0.008) was found as well as statistically significant weak negative correlation between ADC1 and posterior atlanto-axial diameter interval PADI (rho =  - 0.34; p < 0.008).


The conducted study demonstrates the applicability of the ADC maps in the identification of spinal cord compression due to anterior AAS in RA patients. The results encourage the practical use of the ADC as an additional parameter in the qualification for surgical treatment. These slides can be retrieved under Electronic Supplementary Material.