1. ASNR 2015 Use of a Novel MRI-Compatible Head-Positioning Device for the Three Dimensional Kinematic Analysis of the Cervical Spine in Axial Rotation 1. Student, Illinois Mathematics and Science Academy, Aurora, IL, USA 2. PhD Candidate, Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, USA 3. Professor and Director, Spine Biomechanics Laboratory, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA 4. Assistant Director, Spine Biomechanics Laboratory, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA 5. Professor, Department of Radiology, Northwestern University, Chicago, IL, USA Poster #: EP-153 Authors and Affiliations Jyotsna Bitra 1, Jessica Phung 1, Kenneth A. Weber II 2, Nozomu Inoue 3, Alejandro A. Espinoza Orías 4, and Todd B. Parrish 5

2. ASNR 2015 The authors have no disclosures. Disclosures

3. ASNR 2015 Cervical Spine Anatomy ●Upper Cervical Spine ○Occiput = C0 ○Atlas = C1 ○Axis = C2 ○Most of the axial rotation occurs between C1 and C2 ●Lower Cervical Spine ○C3-C7 ●Intervertebral Joints ○Intervertebral discs between adjacent vertebrae ○Fibrocartilaginous joint ○Shock absorbers ●Facet Joints o Synovial planar joints o Between adjacent superior and inferior articulating processes Austin et al., 2014

4. ASNR 2015 Segmental Motion Ishii, T., et al. (2004) ●3D cervical spine segmental motions (6 degrees of freedom) ○+/- Rotations around X,Y, and Z axes ○+/- Translations along X, Y, and Z axes ●Characteristic coupled segmental motions of the cervical spine

5. ASNR 2015 Previous Studies ● Ishii T et al. 2004 ○ Imaged healthy patients in 15 degree intervals of axial head rotation ○ 1.0 T MRI Scanner ○ Calculated 3D segmental motions using a voxel-based registration technique ● Upper Cervical Spine ○ Coupled lateral bending with axial rotation in the direction opposite of axial rotation at C0-C1 and C1-C2 ○ Coupled extension with axial rotation at C0-C1 and C1-C2 ● Subaxial Cervical Spine ○ Coupled lateral bending with axial rotation in the same direction of axial rotation at all levels ○ Coupled extension with axial rotation occurred at C2-C3, C3-C4, and C4-C5 ○ Coupled flexion with axial rotation at C5-C6, C6-C7, and C7-T1 ● No head-positioning device was used to control position of the head relative to the thorax

6. ASNR 2015 Purpose 1.MRI allows a non-invasive method of analyzing cervical spine segmental motion 2.Previous studies failed to utilize a head-positioning device to control the amount of angular displacement of the head relative to thorax 3.Design and test an MRI-compatible head-positioning device to image the cervical spine with controlled axial rotation of head Windsor, R.E, (2014).

7. ASNR 2015 Head-Positioning Device ● MRI-compatible device made from ABS (acrylonitrile butadiene styrene) plastic and football helmet (Riddell, Rosemont, IL, USA) ●Wheel and axle design ● Allows for 180 degrees head rotation

8. ASNR 2015 Imaging ●Siemens TIM Trio 3.0 T Scanner ● Two 4-channel flex coils were placed anterior and posterior to the head and neck while scanning ●Imaged using navigated multi-echo (4) 3D MPRAGE acquisition with IPAT ○TE 2 ms, TR 2540 ms, flip angle 7°, ○1 average, 1 mm x 1 mm x 2 mm voxels ○ Acquisition time 5.5 minutes per image ● 4 males, 2 females (mean age 33.5+- 8.2 years) with no complaints of neck pain ● Subjects were scanned in three different positions of axial head rotation ○ Neutral, 40 degrees of right head rotation, and 40 degrees of left head rotation

9. ASNR 2015 MRI Images Using the Head Positioning Device 40° Right Rotation40° Left RotationNeutral Mimics 16.0, Materialise NV, Leuven, Belgium RL S I

10. ASNR 2015 Manual Segmentation of Cervical Vertebrae 40° Right Rotation40° Left RotationNeutral Mimics 16.0, Materialise NV, Leuven, Belgium RL S I

11. ASNR 2015 Render 3D Models from Vertebral Masks 40° Right Rotation40° Left RotationNeutral Mimics 16.0, Materialise NV, Leuven, Belgium RL S I

12. ASNR 2015 Calculation of 3D Segmental Motions using the Volume Merge Method Render 3D ModelsPoint Cloud Format Transformation of neutral vertebra to transformed vertebra Ochia, R.S. et al., (2006)

13. ASNR 2015 Coupled Segmental Motion ●Expected approximately 40° of axial rotation throughout the cervical spine ●Average axial rotation summed across all segments ●34.8° ± 13.8° left rotation during left head rotation ●41.3° ± 6.5° right rotation during right head rotation ●Translations along each axis can also be calculated LR= Left Head Rotation, RR = Right Head Rotation Rx = + Flexion, - Extension Ry = + Right Lateral Flexion, - Left Lateral Flexion Rz = + Left Axial Rotation, - Right Axial Rotation

14. ASNR 2015 Conclusions ●The device allowed for the precise control of axial head rotation while in the MRI scanner ●All subjects were able to tolerate the device and head positioning throughout the scans ● Image quality was adequate to manually segment the data ● Our results were similar to previously published studies ● In the future, the feasibility of using this device in a neck pain population will be assessed

15. ASNR 2015 References ●Austin N, Krishnamoorthy V, Dagal A. Airway management in cervical spine injury. International Journal of Critical Illness and Injury Science. 2014;4(1):50-56. ●Ishii T, Mukai Y, Hosono N, Sakaura H, Nakajima Y, Sato Y, Sugamoto K, Yoshikawa H. Kinematics of the upper cervical spine in rotation: in vivo three-dimensional analysis. Spine. 2004 Apr 1;29(7):E139-44. ●Ishii T, Mukai Y, Hosono N, Sakaura H, Fujii R, Nakajima Y, Tamura S, Sugamoto K, Yoshikawa H. Kinematics of the subaxial cervical spine in rotation in vivo three-dimensional analysis. Spine. 2004 Dec 15;29(24):2826-31. ●Ochia RS, Inoue N, Renner SM, Lorenz EP, Lim TH, Andersson GB, An HS. Three-dimensional in vivo measurement of lumbar spine segmental motion. Spine (Phila Pa 1976). 2006 Aug 15;31(18):2073-8.

16. ASNR 2015 Acknowledgments Authors and Collaborators: Parrish Neuroimaging Laboratory Department of Radiology Northwestern University Center for Translational Imaging Todd B. Parrish, PhD Kenneth A. Weber II, DC Jennie Chen, PhD Xue Wang, PhD Brian Williams, BSN, RN Rush University Medical Center Spine Biomechanics Laboratory Nozomu Inoue, MD, PhD Alejandro A. Espinoza Orías, PhDí Funding Support NCMIC Foundation, Inc. NCCIH F32AT007800 NICHD T32HD057845