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"Whiplash injuries" are frequent sequelae of motor vehicle accidents. While conventional imaging methods such as X-ray, including special and functional lateral projections, continue to be the first-choice evaluation methods, they frequently do not reveal injuries to the soft tissues. Cross-sectional methods such as CT and MRT may therefore be indicated for further workup in given clinical situations. In this paper the role of the entire spectrum of imaging methods is reviewed. Emphasis is placed on so-called functional CT, which allows detection of rotational instabilities of the upper cervical spine. These are difficult to evaluate clinically or by standard imaging studies, yet they may be a frequent cause of chronic whiplash syndrome. Furthermore, some results of morphologic studies of the alar ligaments by MRT are presented. Although experience to date is limited, it is likely that MRT of the occipitocervical junction region due to its potential to reveal exquisite anatomical detail, will gain in importance in the future.

A functional rotatory computed tomography (CT) study of 423 whiplash patients with cervical spine soft-tissue injury was undertaken to determine its diagnostic value. The results are correlated with previous CT studies on normal subjects, and an evaluation of paradox motion, in which the lower vertebra rotates more than the vertebra immediately superior to it, is given. Asymmetrical left/right rotation reached the pathological value in 36% of the patient population at the level of C0-1. Twice as many patients had hypermobile rotation to the left as compared with the right, perhaps indicating that the right alar ligament is more often damaged in injuries involving the whiplash mechanism. A higher percentage of pathological values for hypermobile rotation was found at the level of C0-1 than at C1-2. Patients exhibiting paradox rotation had a significantly higher amount of rotation to the contralateral side than did those who exhibited no paradox rotation. These findings validate the use of functional rotatory CT in the evaluation of soft-tissue damage of the upper cervical spine resulting from whiplash injury.

Two cases of gliomatosis cerebri which underwent serial CT-examination with contrast enhancement and histological examination of autopsy material are presented. No one single CT showed all the lesions discovered on neuropathological examination, the lesions in the brainstem, basal ganglia and cerebellum being isodense. The presentation of the lesions on CT was in both cases different. In one case there were several hypodense areas predominantly scattered throughout the white matter of both hemispheres, in the other the main lesion was a "tumor' of the corpus callosum, which lead to the decision for operation. Both cases showed periventricular enhancement expressing the histologically verified periventricular spread of tumor cells. Contrast enhancement appeared in the late stages of the diseases. In the different diagnosis, pseudotumor cerebri, multiple sclerosis, encephalitis and multiple brain metastases are considered. Bearing the possibility of gliomatosis cerebri in mind, CT would help limit the differential diagnosis, especially on the basis of serial CT examinations and in combination with the clinical course.

The computed tomography (CT) findings in a verified case of neuronal ceroid lipofuscinosis (NCL) are presented. CT revealed diffuse and severe cerebral atrophy, reflected by generalized subarachnoid space enlargement and symmetric ventricular dilatation. There was no evidence of abnormalities of the white matter. The CT features in our case of NCL correspond perfectly with the neuropathologic changes of the disease mentioned in the literature. Furthermore, CT is of considerable help in differentiating between those inherited metabolic brain diseases characterized primarily by white matter involvement and those presenting predominantly with changes of grey matter.

The computed tomography (CT) findings of 105 patients with a total of 139 intracranial aneurysms are analyzed. The rate of detection of subarachnoid and intracerebral hemorrhage in relation to time since bleeding episode agreed well with previously reported results. Direct visualization of small intracranial aneurysms using 5 mm sections in the postcontrast scan was possible in 58% of the cases. Ten cases of giant intracranial aneurysms (GIA) more than 25 mm in diameter are analyzed in depth. Diagnostic criteria for differentiation of GIA from tumors are discussed. Ring shaped postcontrast enhancement of the outer margin of the aneurysm or curvilinear interrupted calcifications were found in totally or partially thrombosed GIA; central or peripheral homogeneous enhancement of the aneurysm's lumen (target sign) was typical of partially thrombosed GIA; and nonthrombosed GIA usually presented as homogeneously enhancing lesions. Differential diagnostic criteria are discussed.

A detailed analysis of the CT findings in 16 surgically verified cases of meningioma of the posterior surface of the petrous bone is presented. The results indicate that a correct preoperative diagnosis is possible in almost every case. Frequently occurring specific CT criteria for meningioma of the posterior surface of the petrous bone include: hyperdense, homogeneously enhancing, extra-axial, CPA mass; inverse relationship between precontrast attenuation value and degree of contrast enhancement of the tumor; oval shape; obtuse angle between lateral tumor border and posterior surface of petrous bone, and evidence of transcisternal supratentorial tumor extension. Infrequently occurring specific CT criteria include: tumor calcification; hyperostosis or exostosis of the posterior surface of the petrous bone; a comma-shaped tumor configuration in cases with transcisternal tumor extension and evidence of transtentorial tumor extension. Oxygen CT cisternography is the most sensitive and reliable technique for detecting small tumors. The CT differential diagnosis of meningioma of the posterior surface of the petrous bone is discussed.

The evaluation by means of functional x-rays, of rotatory instability of the upper cervical spine as a result traumatic or inflammatory destruction of the ligamentous apparatus, is unsatisfactory. Functional CT of the upper cervical spine allows measurement of the segmental rotatory movements. 9 healthy adults and 30 patients were examined after neck injury via functional CT's. A rotation between occiput and atlas greater than 9 degrees, between atlas and axis over 50 degrees, the left-right difference at the level C0/C1 greater than 6 degrees and at the level C1/C2 over 10.5 degrees point to a suspicion of hypermobility or instability.

A case of surgically verified cerebral granulomatous angiitis, which was mistaken for a brain tumor on computed tomography, is reported. The focal, enhancing lesion was due to multiple confluent infarction caused by the angiitic process.

Nine healthy adults and 43 patients with cervical spine injury were examined by using functional (computerized tomography) CT scanning. The ranges of axial rotation at the levels occiput C0-C1, C1-C2, and C2-C3 were measured. A rotation at C0-C1 greater than 8 degrees; at C1-C2, 56 degrees; or a right-left difference C0-C1 greater than 5 degrees and C1-2 greater than 8 degrees indicates hypermobility. A rotation at segment C1-C2 of less than 28 degrees indicates hypomobility. Surgical stabilization of rotatory instability could be considered as a possible therapeutic procedure.

At present, there are few methods that are of any assistance in evaluating the ligaments of the upper cervical spine. It is obvious that a lesion of these ligaments could result in instability of the cranial cervical junction. Nine healthy adults and 45 patients with suspected rotatory instability of the upper cervical spine after trauma were examined using functional CT-scans. After CT scans of the upper cervical spine had been obtained with the patient in a neutral position, the head was passively rotated to the left and right and held in these positions by adhesive tape. CT scans were performed for the left and right rotation. The range of axial rotation was measured in relation to the neutral position at the level of the occiput, atlas and axis using identical bony landmarks. A mean rotation of 4.2 degrees to the right and 3.8 degrees to the left was measured at the occiput/atlas level. The mean difference between left and right rotation in individual patients was 2 degrees. The mean rotation of C1-2 was 41.8 degrees to the right and 44.3 degrees to the left. The mean difference between left and right rotation was 2.8 degrees. A 98% confidence interval for allocating a pathological case to the distribution of healthy adults was defined. According to this rule, occiput/atlas rotation of 8 degrees or more, C1-2 rotation of 56 degrees or more, a left/right OCC/C1 difference of 5 degrees or more and a left/right C1-2 difference of 8 degrees or more were considered to be pathological.(ABSTRACT TRUNCATED AT 250 WORDS)

35 healthy adults and 137 patients after cervical spine injury were examined by functional CT. The range of axial rotation at the level occiput/atlas, atlas/axis and the segment below were measured in all subjects. A rotation occiput/atlas of more than 7 degrees, and C1/C2 more than 54 degrees could indicate segmental hypermobility, a rotation at the segment C1/C2 less than 29 degrees to hypomobility. According to the postulated normal values based upon a 98% confidence level, out of 137 patients examined after cervical spine injury and with therapy-resistant neck pain, 45 showed signs of segmental hypermobility of the upper cervical spine, 17 showed hyper- or hypomobility at different levels, 10 patients presented segmental hypomobility at C1/C2 level alone. In all patients, according to the clinical assessment, functional pathology was suspected in the upper cervical spine. Surgical correction of rotary instability should be considered as a possible therapeutic procedure after successful diagnostic stabilisation of the cervical spine by minerva cast.