350 likes | 1.17k Views
SPINAL CORD. Dr. Sajjad Hussain Faculty in Neuroradiology Department of Radiology and Medical Imaging King Saud University / King Khalid University Hospital. Imaging Methods to Evaluate Spine Plain X-Ray Films - bones
E N D
SPINAL CORD Dr. Sajjad Hussain Faculty in Neuroradiology Department of Radiology and Medical Imaging King Saud University / King Khalid University Hospital
Imaging Methods to Evaluate Spine • Plain X-Ray Films - bones • Myelogram – injection of contrast medium in CSF followed by x-ray images. Rarely performed now-a-days • Computed Tomography (CT Scan) • Magnetic Resonance Imaging (MRI) • Spinal angiography – to evaluate arteries and veins • Ultrasound – more in children • Radionuclide Bone Scan – intravenous injection of radioactive material bound to phosphonates which deposit in bones, followed by images by gamma camera. • DEXA – radionuclide scan for bone density (osteoporosis)
X-RAYS (RADIOGRAPHS) Often the first diagnostic imaging test, quick and cheap Small dose of radiation to visualize the bony parts of the spine Can detect Spinal alignment and curvature Spinal instability – with flexion and extension views Congenital (birth) defects of spinal column Fractures caused by trauma Moderate osteoporosis (loss of calcium from the bone) Infections Tumors May be taken in different positions (ie; bending forward and backward) to assess for instability
COMPUTERIZED TOMOGRAPHY (CT SCAN) Uses radiation Obtain 2-D images can be processed to 3-D images Patients lies on a table that moves through a scanner Much detailed information regarding bony structures Limited information about spinal cord & soft tissues Entire spine can be imaged within a few minutes
Magnetic Resonance Imaging (MRI) Gold standard of imaging for spinal cord disorders No radiation Can identify abnormalities of bone, soft tissues and spinal cord Patient lies still on a table that moves through a tunnel like structure Takes about 15 - 25 minutes Claustrophobic patients, uncooperative / semiconscious patients, and children may need sedation or general anesthesia Contraindications include implanted devices e.g. cardiac pacemakers, electromagnetic devices, certain metal clips and stimulators Artificial joints and other fixed metals no problem
Abnormalities of spinal cord Congenital Trauma Demyelination Tumors Ischemia
Antenatal US Antenatal MRI
24 years old with paraplegia after road traffic accident since 3 years
Hyperflexion fx with ligamentous disruption and cord contusion
Vertebral Artery Dissection/Occlusion Secondary to C6 Fracture
Cord Edema As in the brain, may be secondary to ischemia (e.g. embolus to spinal artery) or venous hypertension (e.g. AV fistula)
Transverse Myelitis Inflamed cord of uncertain cause Viral infections Immune reactions Idiopathic Myelopathy progressing over hours to weeks DDX: MS, glioma, infarction
Multiple Sclerosis Inflammatory demyelination eventually leading to gliosis and axonal loss T2-hyperintense lesion(s) in cord parenchyma Typically no cord expansion (vs. tumor); chronic lesion may show atrophy
Key Points for MS, Transverse myelitis, and ADEM MS lesions in spinal cord are more likely multiple, focal and peripherally located don’t cover the entire section on axial images often < 2 vertebral body heights on sagittal images are disseminated in time and space may enhance in acute phase Transverse myelitis lesions extend over >3 vertebral body heights on axial images often > 4 vertebral body heights on sagittal images no brain lesions ADEM and NMO lesions in spinal cord – similar but presence of Brain lesions ADEM Optic nerve lesions NMO
SYRINGOHYDROMYELIA Seen with: • congenital lesions • Chiari I & II • tethered cord • acquired lesions • trauma • tumors • arachnoiditis • idiopathic
SYRINX On imaging, a syrinx is a longitudinally oriented CSF-filled cavity with surrounding myelomalacia / gliosis may have a beaded or cystic expansile configuration