A Study of the Upper Cervical Spine in Long-term Hemodialysis Patients.

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In 1990 Rousselin et al. reported pseudotumor of the periodontoid soft tissue mass in patients on long-term hemodyalysis. Our study of the upper cervical spine was performed using magnetic resonance imaging and X-ray in 20 patients (15 males and 5 females). The mean age of subjects was 53 years (ranging from 35 to 78 years). They were treated with long-term hemodialysis for a mean of 9 years (ranging from 4 to 24 years).Plain radiography demonstrated vertical atlantoaxial subluxation in two, and one showed a fracture of the odontoid process. The other showed an irregular feature of the atlantoaxial joint.Pseudotumor of the periodontoid soft tissue was observed in 5 cases (25%) by MRI. The mean duration of dialysis in patients with pseudotumor was 17.7 years, and that in patients without it was 7.4 years. The duration of dialysis in the pseudotumor group was significantly older than that in the non pseudotumor group (P<0.01). There was no significant difference in β2 microglobulin between the 2 groups. In T1-weighted MRI sequences, the signal intensity of the soft tissue mass was lower or equal than that of the spinal cord. In T2-Weighted sequences, the abnormal masses exhibited low intensity in 4 patients, and of high intensity in one patient. These Pseudotumor are suggestive of β2 microglobulin amyloidosis.MRI appeared to be very useful for the demonstration of the periodontoid soft tissue mass.
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