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Neuro -Radiology

Neuro -Radiology. SPINE. Raj Reddy Neurosurgery Prince of Wales Hospital. Objectives. R eview spine anatomy on X- ray, CT and MRI A pproach to interpretation of imaging Differential diagnoses for common spine lesions. Imaging Modalities. Basic Imaging Types. X-ray

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Neuro -Radiology

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  1. Neuro-Radiology SPINE Raj Reddy Neurosurgery Prince of Wales Hospital

  2. Objectives • Review spine anatomy on X-ray, CT and MRI • Approach to interpretation of imaging • Differential diagnoses for common spine lesions

  3. Imaging Modalities

  4. Basic Imaging Types • X-ray • CT (Computed Tomography) • MRI (Magnetic Resonance Imaging) • Angiography

  5. X-ray • Limited Use • Evaluation of: • Bones (fractures) • Calcification

  6. Computed Tomography http://fitsweb.uchc.edu/student/selectives/TimHerbst/intro.htm

  7. Computed Tomography (CT) • Tomography • Imaging in sections, or slices • Computed • Geometric processing used to reconstruct an image • Computerized algorithms

  8. Computed Tomography • Uses X-rays • Dense tissue, like bone, blocks x-rays • Gray matter weakens (attenuates) the x-rays • Fluid attenuates even less • A computerized algorithm (filtered backprojection) reconstructs an image of each slice

  9. CT Image Formation X-ray tube X-ray X-ray detector

  10. CT Image Formation Backprojection

  11. CT Image Reconstruction – 6 Slices

  12. CT Image Reconstruction – 12 Slices

  13. CT Image Reconstruction – Final

  14. Magnetic Resonance Imaging

  15. What is MR? • Not an X-ray, electromagnetic • Electromagnetic field aligns all the protons in the brain • Radiofrequency pulses cause the protons to spin • Amount of energy emitted from the spin is proportional to number of protons in the tissue • No ferromagnetic objects

  16. Angiography

  17. Angiography • Real time X-ray study • Catheter placed through femoral artery is directed up aorta into the cerebral vessels • Radio-opaque dye is injected and vessels are visualized • Gold standard for studying cerebral vessels.

  18. Angiography AP Right ICA Lateral Right ICA

  19. Angiography AP Right Vertebral

  20. Planes of Section • Axial (transverse) • Sagittal • Coronal • Oblique

  21. Anatomy

  22. Radiographic Anatomy

  23. Cervical Spine – AP View

  24. Cervical Spine – Lateral View

  25. Cervical Spine – Open-Mouth (Dens) View

  26. Cervical Spine – Oblique View

  27. Lumbar Spine – AP View

  28. Lumbar Spine – Lateral View

  29. Approach to Xrays

  30. Approach to Spine Imaging A –adequacy/alignment B – bone C – cord/canal/cartilage D – disc E – extras

  31. C7-T1

  32. Alignment 1. prevertebral 2. anterior spinal 3. posterior spinal 4. spino-laminar

  33. Cartilage • Predental Space should be no more than 3 mm in adults and 5 mm in children • Increased distance may indicate fracture of odontoid or transverse ligament injury

  34. Cartilage • Disc Spaces • Should be uniform • Assess spaces between the spinous processes

  35. Soft tissue • Nasopharyngeal space (C1) - 10 mm (adult) • Retropharyngeal space (C2-C4) - 5-7 mm • Retrotracheal space (C5-C7) - 14 mm (children), 22 mm (adults) • Extremely variable and nonspecific

  36. CT Anatomy

  37. CT

  38. MRI Anatomy

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