PMC6764256_01
(a) Sagittal, (b) coronal and (c) axial CT-scan reformations of the upper cervical spine in a 30-year-old woman, showing the mixed appearance of the C2 vertebral body with a ground-glass appearance and osteolytic areas in the base of the odontoid process with a pathologic fracture (thin arrow) and in the inferior part of the vertebral body with partial destruction of the inferior endplate (thick arrow).
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F1
C2. CT confirmed the fracture of the odontoid process and the replacement of normal bone by ground-glass mineralization and a centimetric lytic area with poorly defined margins involving the inferior part of the vertebral body and inferior endplate (Figure 1).
T2-weighted, T1-weighted, T1-weighted with intra-venous contrast administration midline sagittal MR images of the cervical spine showing the low signal intensity of the C2 vertebral body and odontoid process (a, b), with enhancement after contrast administration (c), and a solution at the junction between the odontoid process and vertebral body (a-c).
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F2
T1- and T2-weighted images, with mild homogenous enhancement after gadolinium administration that suggested a fibrous and/or mineralized content (Figure 2). There was no soft tissue extension and the C2-3 intervertebral disc was normal.
Percutaneous needle biopsy of C2 under fluoroscopic guidance with an anterolateral approach.
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F3
A 11-gauge 10-cm-long coaxial biopsy needle (KBC1110, Merit Medical , Galway, Ireland) was advanced up to C2 vertebral body through an anterolateral ascending approach between the jugulo-carotid bundle and the trachea-oesophagus, and bone samples from C2 vertebral body were obtained (Figure 3).