1.Calcification of the Alar Ligament Mimics Fracture of the Craniovertebral Junction (CVJ): An Incidental Finding from Computerised Tomography of the Cervical Spine Following Trauma
Siti Kamariah Che Mohamed ; Azian Abd. Aziz
Malaysian Journal of Medical Sciences 2009;16(4):69-72
When performing a radiological assessment for a trauma case with associated head injury,
a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as
a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with
computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of
ligament calcification would be considered. We present a case involving a previously healthy 44-yearold
man who was admitted following a severe head injury from a road traffic accident. CT scans of
the head showed multiple intracranial haemorrhages, while scans of the cervical spine revealed a
small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a
fracture fragment. Although such calcification is uncommon, accident and emergency physicians and
radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or
traumatic head injury.
2.Computed Tomography (CT) of Bowel and Mesenteric Injury in Blunt Abdominal Trauma: A Pictorial Essay
Radhiana Hassan ; Azian Abd Aziz ; Siti Kamariah Che Mohamed
The Medical Journal of Malaysia 2012;67(4):445-452
Computed tomography (CT) is currently the diagnostic
modality of choice in the evaluation of clinically stable
patients with blunt abdominal trauma, including the
assessment of blunt bowel and mesenteric injuries. CT
signs of bowel and/or mesenteric injuries are bowel wall
defect, free air, oral contrast material extravasation,
extravasation of contrast material from mesenteric vessels,
mesenteric vascular beading, abrupt termination of
mesenteric vessels, focal bowel wall thickening, mesenteric
fat stranding, mesenteric haematoma and intraperitoneal or
retroperitoneal fluid. This pictorial essay illustrates CT
features of bowel and/or mesenteric injuries in patients with blunt abdominal trauma. Pitfalls in interpretation of images are emphasized in proven cases.
3.Computed Tomography (CT) of Blunt Abdominal Trauma:The Frequency of Incidental Findings, how it was Documented in Radiology Report and the Implication of These Findings to Acute Trauma Care
Radhiana Hassan ; , Siti Kamariah Che Mohamed ; Mohd Nazli Kamarulzaman
The Medical Journal of Malaysia 2014;69(1):46-48
The wide use of computed tomography (CT) scanning for
patients with blunt abdominal trauma can reveal incidental
findings that vary in their importance. We evaluated these
findings, how it was reported by radiologists and its
implication on the trauma care. In 30 out of 154 patients, 32
incidental findings were discovered (19.5%). Out of these 32
findings, only 3 cases (9.4%) were considered significant
and required immediate attention from the managing team.
In all these 3 cases, the findings were described in the body
of the report and highlighted in the conclusion section at the
end of the radiology report. However, similar reporting style
was used in only 58.4% of cases with moderate clinical
concern and 23.5% of cases with little clinical concern. In
41.2% of cases with little concern, the incidental findings
were not mentioned in the radiology report. In conclusion,
incidental findings in CT scan performed for blunt
abdominal trauma were common but many were clinically
insignificant. There is little consistency in radiology
reporting of these findings especially those with moderate
and little clinical concern.
4.Retrocaval Ureter: The Importance of Intravenous Urography
Radhiana Hassan ; Azian Abd Aziz ; Siti Kamariah Che Mohamed
Malaysian Journal of Medical Sciences 2011;18(4):84-87
Retrocaval ureter is a rare cause of hydronephrosis. Its rarity and non-specific presentation pose a challenge to surgeons and radiologists in making the correct diagnosis. Differentiation from other causes of urinary tract obstruction, especially the more common urolithiasis, is important for successful surgical management. Current practice has seen multislice computed tomography (MSCT) rapidly replaces intravenous urography (IVU) in the assessment of patients with hydronephrosis due to suspected urolithiasis, especially ureterolithiasis. However, MSCT, without adequate opacification of the entire ureter, may allow the physician to overlook a retrocaval ureter as the cause of hydronephrosis. High-resolution IVU images can demonstrate the typical appearance that leads to the accurate diagnosis of a retrocaval ureter. We reported a case that illustrates this scenario and highlights the importance of IVU in the assessment of a complex congenital disorder involving the urinary tract.
5.Characterization of Alar Ligament in Young Adult on 3.0T MRI: A Cross-sectional Study in IIUM Medical Centre, Kuantan
Raihanah Haroon ; Siti Kamariah Che Mohamed ; Karimah Hanim Abd. Aziz
Malaysian Journal of Medicine and Health Sciences 2023;19(No.1):149-157
Introduction: Alar ligament is a paired craniocervical junction ligaments which stabilizes the atlantooccipital and
atlantoaxial joints. The main purpose of the study was to compare the normal anatomy of alar ligament on MRI between male and female. The prevalence of alar ligament visualized on MRI and its characteristics were also studied
apart from determining the association between the heights of respondents with alar ligament signal intensity and
dimensions. Methods: Fifty healthy volunteers were studied using 3.0T MR scanner (Siemens Magnetom Spectra) by
2-mm proton density, T2 and fat-suppression sequences. Alar ligament visualization, dimensions and variability of
the ligament courses, shapes and signal intensity characteristics were determined. Results: The orientation of the ligament was laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed
inhomogenous signal. Females are 70% less likely to exhibit alar ligament signal inhomogeneity than males. There
were positive correlation between height and the craniocaudal diameter of the alar ligament as well as the anteroposterior diameter, which were statistically significant (r = 0.25, n = 100, p = 0.01 and r = 0.201, n = 100, p = 0.045
respectively). Conclusion: Tremendous variability of alar ligament shows that clinical and multimodality correlation
needs to be exercised, especially in evaluating alar ligament MR signal in male. Taller individuals otherwise tend to
have longer and thicker ligaments. Future studies with larger samples of alar ligaments including trauma cases are
also recommended to supplant a new classification system of alar ligament injury.
6.Magnetic Resonance Imaging Anatomy of Alar Ligament: A Review of Literature
Raihanah Haroon ; Siti Kamariah Che Mohamed ; Karimah Hanim Abd. Aziz
Malaysian Journal of Medicine and Health Sciences 2023;19(No.5):389-398
Alar ligament is one of the most important craniocervical junction (CCJ) ligaments; acting as stabilizer of CCJ and
limiting axial rotation. It may be involved in various pathological processes including trauma. Magnetic resonance
imaging (MRI) is increasingly being used in cervical spine trauma as a supplement to conventional radiography and
computed tomography (CT) to detect a wide range of severe cervical spine injuries. MR depiction of alar ligament
requires special sequences despite no known established MR sequence is available. However, the role of MRI in
minor or moderate trauma, including whiplash injuries, has long been debated, particularly when neurological dysfunction is absent, because no anatomical disruption other than degenerative disc disease have been reported. In this
review, we provide detailed account on the current knowledge of MR visualization of normal alar ligament; outlining
the variations in its signal intensity, dimension, shape and orientation.