ct scan coronal reconstruction of the cervical spine illustrating a fracture of the bodies of c4 and...

Prepared By:Ala’a Ali Tayem Abed

Computed Tomography – II

RAD - 473

Lecture 5, 6

Spinal CT Scan

Spinal CT Scan

A CT Scan of the Spine may be Performed to: • Look at the Bones of the Spine (Vertebrae).• Assess the Spine for a Herniated Disk.• Low Back Pain.• Tumors and Other Lesions.• Injuries and Fractures.• Structural Anomalies such as Spina Bifida (a type of Congenital Defect of the Spine).• Degenerative Spine Disease, such as; Spinal Stenosis, Spondylolisthesis.• Blood Vessel Malformations.• Other conditions, particularly when another type of examination, such as X-rays or physical examination, is not conclusive.• CT of the Spine may also be used to Evaluate the Effects of Treatment of the Spine, such as Surgery or Other Therapy.

Protocol: Patient Position: Supine, for Dorsal and Lumber Spine; Arms Elevated Above Head. Topogram Direction: Craniocaudal. Scan Range: The vertebrae should be centered in the field of view. Include the complete Spinous processes and transverse processes of the vertebrae of interest in the scan. Do not include the pelvis and ribs in the field of view (if possible) Do not include the table in the field of view. Do not include more tissue than necessary; only bone structure should be visible.

COVERAGE: 1. C - Spine: Base of skull to Top of T3.

2. T - Spine: Bottom of C6 to Top of L2.

3. L - Spine: Bottom of T10 to Top of Sacrum. Breath Hold: Suspend Expiration. kVp / effective mA / Rotation time (sec):120 kVp / 300 mA / 0.75 sec Slice Thickness: 3 – 7.5 mm. Reconstruction: 1. Spine Bone Window: 3mm, (WW=2000, WL=200). 2. Spine Soft Tissue Window : 3mm, (WW = 350, WL = 50). Reformation: 1. Reformat the Sagittal off of Coronals, and Coronal off of Sagittal. 2. For spines that are very curved additional reformats may be needed.

Curved Reformats

CT Scan coronal reconstruction of the cervical spine illustrating a fracture of the bodies of C4 and C5.

Spinal Fractures, C - Spine

These are two reformatted CT images of the cervical spine. The green arrows point to a transverse fracture of the base of the dens (odontoid).

Sagittal Reconstruction of a CT Scan Showing a Cervical Fracture with Dislocation at the Level of C6/7

Spinal FracturesT - Spine

CT scan - Sagittal (T4 fracture dislocation and L4 fracture ).

Spinal Fractures, T - Spine

Sagittal reformatted CT- image (1) shows Fracture of D8 over D9. (2) Coronal images show lateral translation at the same level. (3) Axial CT- image 3 shows “Double vertebral body” at the level of fracture.

Spinal Fractures, L - Spine

Computed Tomography (CT) Scan of the Lumbar Spine (Shown by Compression Fracture of the Spine).

A CT Scan taken from the Side of a Burst Fracture in the Lumbar Spine.

CT scan was performed and showed a fracture-dislocation centered on L4 vertebra.

Spinal Fractures, L - Spine

CT scan shows a collapsed, compressed osteoporotic fracture in L3.

Initial sagittal computed tomography scan showing herniation of the C5-C6 calcified disk located at the central and posterior border (arrow).

Herniated Disk, C - Spine

Axial and Sagittal CT scans of T6-T7.There is a calcified disc protruding into the spinal canal, extending from the midline and more prominent to the left.

Herniated Disk, T - Spine

Herniated Disk, L - Spine

This sagittal reconstruction of the lumbar spine obtained following a lumbar discogram shows contrast, (white), within the L4/5 disc which has a normal appearance. The appearance of contrast within the L5/S1 disc is abnormal demonstrating a degenerated disc with a mild posterior disc protrusion/herniation.

CT of lumbar spine: seen is an incomplete closure of the spine's lamina (spina bifida)

Magnetic resonance imaging (MRI) scan of a sagittal section - Spina bifida.

Spina Bifida

Sagittal CT through the lumbar spine revealing an additional lucent line in the posterior elements of the L4 vertebral body (black arrow).

Spondylolysis

The CT scan shows the relevant anatomy of a normal pars interarticularis and one that exhibits spondylolysis.

Spondylolysis

Midline sagittal CT scan again demonstrates the L5-S1 spondylolisthesis.

Spondylolisthesis

Preoperative sagittal CT scan showing spondylolisthesis.

CT scan – C5 spondylolisthesis. CT scan – C5 spondylolisthesis postoperative.

Spondylolisthesis

Non- contrast CT Scan of the entire spine shows diffuse multiple osteolytic lesions.

Spinal Lesions

CT scan, Tumor at C2-C3

C2

C3

Spinal Lesions, C - Spine

Bone metastases: Sagittal CT of the thorax in bone windows shows multiple lesions.

Reconstruction images of the CT chest showing multiple osteoblastic lesions in thoraco-lumbar vertebrae.

Skeletal changes in myeloma, thoracic spine.

Spinal Lesions, T - Spine

Sagittal (A) and axial (B) computed tomography scans showing an osteolytic lesion of the L4 vertebral body.

Spinal Lesions, L - Spine

Sagittal CT reformation of the lumbar spine (a) shows a large sclerotic lesion nearly completely involving the L5 vertebral body.

Post-operative CT scan showing screws and plate in cross-section.

Post-Treatment Images

Post-Treatment Images

Post-op axial CT scans showing cage and pedicle screw placement.

Post-op sagittal CT scan (left) and coronal CT scan (right) showing adequate spondylolisthesis reduction.

Post-Treatment Images

Thank You

Best Wishes For All