medical imaging of spine
TRANSCRIPT
-
8/10/2019 medical imaging of spine
1/112
1
-
8/10/2019 medical imaging of spine
2/112
2
-
8/10/2019 medical imaging of spine
3/112
3
For imaging of the spine one routinely uses conventional X-ray, CT and MRI.
On X-ray and CT, one can visualise the bony structures as well as the soft tissues.
MRI allows to visualise soft tissues, ligaments, discs, and the myelum, as well as thebone marrow, but not the bone itself.
-
8/10/2019 medical imaging of spine
4/112
4
The cervical spine has 7 vertebra.
-
8/10/2019 medical imaging of spine
5/112
-
8/10/2019 medical imaging of spine
6/112
6
-
8/10/2019 medical imaging of spine
7/112
7
On the AP-view one can see:
1/ bony structures
2/ air (pharynx, larynx, trachea, lungtops)
3/ soft tissues (muscle, skin, )
-
8/10/2019 medical imaging of spine
8/112
8
Are the bony structures of the vertebrae well aligned?
1/ do the proc. transversi form a smooth continuous line?
2/ are all pedicles visible and are they well aligned?
3/ are all proc. spinosi well aligned?
-
8/10/2019 medical imaging of spine
9/112
9
-
8/10/2019 medical imaging of spine
10/112
10
-
8/10/2019 medical imaging of spine
11/112
11
One can perform this lateral view x-ray in a trauma-patient in supine position by
positioning the x-ray tube lateral from the patient.
-
8/10/2019 medical imaging of spine
12/112
12
The lateral view visualises the AP alignment of the vertebrae.
-
8/10/2019 medical imaging of spine
13/112
13
1: C1: atlas
2: C2: dens
-
8/10/2019 medical imaging of spine
14/112
14
-
8/10/2019 medical imaging of spine
15/112
-
8/10/2019 medical imaging of spine
16/112
16
C1 (atlas), C2 (axis) , C7 and D1 are not entirely visualized on X-rays, due to
superimposition of the
- Mandibula and teeth for AP views of C1 and C2.
- clavicula and 1st rib for AP views of C7-D1
- shoulder for lateral views of C7-D1
The open-mouth x-ray visualizes C1-C2 on an AP-view.
-
8/10/2019 medical imaging of spine
17/112
17
-
8/10/2019 medical imaging of spine
18/112
-
8/10/2019 medical imaging of spine
19/112
19
-
8/10/2019 medical imaging of spine
20/112
20
The swimmer X-ray provides good visualisation of C7, since it avoids
superimposition of the shoulders.
-
8/10/2019 medical imaging of spine
21/112
-
8/10/2019 medical imaging of spine
22/112
22
-
8/10/2019 medical imaging of spine
23/112
23
In a !view the X-ray penetrate the subject in an oblique way.
Doing so, the neuroforaminae (neural foramina), through which the nerve roots exit,
become visible.
-
8/10/2019 medical imaging of spine
24/112
24
Spine in a trauma-patient
-
8/10/2019 medical imaging of spine
25/112
25
Visualisation of the neuroforaminae.
Typically a neuroforamen has an oval shape. It resembles a keyhole (round largeopening at the top, smaller oval opening at the bottom)
The nerve root runs in the upper large round part. The lower part is normally filledwith fatty tissue.
-
8/10/2019 medical imaging of spine
26/112
26
-
8/10/2019 medical imaging of spine
27/112
27
-
8/10/2019 medical imaging of spine
28/112
28
-
8/10/2019 medical imaging of spine
29/112
29
Left panel: T1w sagittal slice of the C-spine:
-
Cerebrospinal fluid is dark (hypointense)
-
The disc is gray
- Cortical bone is blcak; the bone marrow is gray (fatty substance)
Right panel: T2 weighted sagittal slice:
- The CSF is hyperintense: it surrounds the myelum
-
The myelum is gray
-
The discs are hyperintense: the are hydrated. Only C2-C3 is dark: dehydration: a
sign of degeneration.
-
8/10/2019 medical imaging of spine
30/112
30
-
8/10/2019 medical imaging of spine
31/112
31
Left panel: Axial T1w slice.
Right panel: Axial T2w slice. Note the anterior en posterior nerve roots, that willfuse into 1 spinal nerve rot.
-
8/10/2019 medical imaging of spine
32/112
32
MR myelogram.
This is a heavily T2w image (long echo time) in which water is selectivelyvisualised: thus, one visualises the CSF.
Note the delineation of the spinal canal, and the nerve roots.
-
8/10/2019 medical imaging of spine
33/112
-
8/10/2019 medical imaging of spine
34/112
34
-
8/10/2019 medical imaging of spine
35/112
35
-
8/10/2019 medical imaging of spine
36/112
36
On an AP-view we try to find the 12 dorsal vertebrae: each has ribs attached to it.
The bifurcation of the trachea superimposes on D5.
-
8/10/2019 medical imaging of spine
37/112
37
-
8/10/2019 medical imaging of spine
38/112
38
-
8/10/2019 medical imaging of spine
39/112
39
In a supine position in a trauma patient
-
8/10/2019 medical imaging of spine
40/112
40
The dorsal spine has a specific curvature: kyphosis.
-
8/10/2019 medical imaging of spine
41/112
41
-
8/10/2019 medical imaging of spine
42/112
42
-
8/10/2019 medical imaging of spine
43/112
43
-
8/10/2019 medical imaging of spine
44/112
-
8/10/2019 medical imaging of spine
45/112
45
-
8/10/2019 medical imaging of spine
46/112
46
-
8/10/2019 medical imaging of spine
47/112
-
8/10/2019 medical imaging of spine
48/112
48
-
8/10/2019 medical imaging of spine
49/112
49
-
8/10/2019 medical imaging of spine
50/112
50
-
8/10/2019 medical imaging of spine
51/112
51
In a supine position in a trauma patient.
-
8/10/2019 medical imaging of spine
52/112
52
The lumbar spine has a specific curvature: lordosis.
-
8/10/2019 medical imaging of spine
53/112
53
-
8/10/2019 medical imaging of spine
54/112
54
-
8/10/2019 medical imaging of spine
55/112
55
On the oblique view of the lumbar spine, the outline of a dog can seen.
The parts of the dog are as follows:
-
the transverse process-the nose;
- the pedicle-the eye;
- the pars interarticularis-the neck;
- the superior articular facet-the ear;
- the inferior articular facet-the front leg.
-
A break in the neck of the dog, or a dog collar, corresponds to a fracture in the
region of the pars interarticularis, which is specific for spondylolysis. It is
important to recognize as it is a cause of low back pain.
-
8/10/2019 medical imaging of spine
56/112
56
A break in the neck of the dog, or a dog collar, corresponds to a fracture in the
region of the pars interarticularis, which is specific for spondylolysis. It is important
to recognize as it is a cause of low back pain.
In case of bilateral spondylolysis the vertebral body can shift
anteriorly: spondylolisthesis.
Spondylolisthesis describes the anterior displacement of a vertebraor the vertebral column in relation to the vertebrae below.
-
8/10/2019 medical imaging of spine
57/112
57
-
8/10/2019 medical imaging of spine
58/112
58
MRI of the lumbar spine:
Left:
T2 and T1 weighted sagittal slices.
The myelum ends at the level of vertebral bodies L1-L2: the conus medullaris.
The conus medullaris ("medullary cone") is the terminal end of the spinal cord.
After the spinal cord tapers out, the spinal nerves continue as dangling nerve roots
called cauda equina.
This terminal nerve root tail is referred to as the filum terminale
Upper right:
Axial T2s slice at the level of the disc L4-L5.
Bottom right:
MR myelogram of the lumbar spine. Normal delineation of the nerve roots.
Centrally in the spinal canal one can see the cauda equina.
-
8/10/2019 medical imaging of spine
59/112
59
-
8/10/2019 medical imaging of spine
60/112
60
-
8/10/2019 medical imaging of spine
61/112
61
Fractures can be caused by excessive
Flexion
Extension
Compression
Or a combination of the above
-
8/10/2019 medical imaging of spine
62/112
-
8/10/2019 medical imaging of spine
63/112
63
-
8/10/2019 medical imaging of spine
64/112
64
-
8/10/2019 medical imaging of spine
65/112
65
Anterior of the vertebral body with a fracture of the superior end-plate.
The posterior wall is intact.
-
8/10/2019 medical imaging of spine
66/112
66
In this case the posterior wall is also fractured.
-
8/10/2019 medical imaging of spine
67/112
67
-
8/10/2019 medical imaging of spine
68/112
68
-
8/10/2019 medical imaging of spine
69/112
-
8/10/2019 medical imaging of spine
70/112
-
8/10/2019 medical imaging of spine
71/112
71
Fractuur van grond naar dekplaat met verplaatsing van de posterieure muur naar
dorsaal, dwz naar/in het spinale kanaal.
-
8/10/2019 medical imaging of spine
72/112
-
8/10/2019 medical imaging of spine
73/112
73
The posterior wall is displaced into the spinal canal. This can cause compression and
injury to the myelum.
-
8/10/2019 medical imaging of spine
74/112
-
8/10/2019 medical imaging of spine
75/112
-
8/10/2019 medical imaging of spine
76/112
76
Aan de anterieure zijde vergroot de tussenwervelruimte.
-
8/10/2019 medical imaging of spine
77/112
77
-
8/10/2019 medical imaging of spine
78/112
78
-
8/10/2019 medical imaging of spine
79/112
79
Traumas die een rotatie letsel kunnen teweegbrengen.
-
8/10/2019 medical imaging of spine
80/112
80
Left: with fracture of the proc. transversus.
Right: rotation of the vertebral body.
-
8/10/2019 medical imaging of spine
81/112
81
Widening of the facet joint.
-
8/10/2019 medical imaging of spine
82/112
82
-
8/10/2019 medical imaging of spine
83/112
83
-
8/10/2019 medical imaging of spine
84/112
84
Traumas die shearing injuries kunnen veroorzaken.
-
8/10/2019 medical imaging of spine
85/112
85
-
8/10/2019 medical imaging of spine
86/112
-
8/10/2019 medical imaging of spine
87/112
87
-
8/10/2019 medical imaging of spine
88/112
88
-
8/10/2019 medical imaging of spine
89/112
89
-
8/10/2019 medical imaging of spine
90/112
-
8/10/2019 medical imaging of spine
91/112
-
8/10/2019 medical imaging of spine
92/112
92
-
8/10/2019 medical imaging of spine
93/112
93
-
8/10/2019 medical imaging of spine
94/112
94
-
8/10/2019 medical imaging of spine
95/112
95
-
8/10/2019 medical imaging of spine
96/112
-
8/10/2019 medical imaging of spine
97/112
97
-
8/10/2019 medical imaging of spine
98/112
98
-
8/10/2019 medical imaging of spine
99/112
99
-
8/10/2019 medical imaging of spine
100/112
-
8/10/2019 medical imaging of spine
101/112
101
-
8/10/2019 medical imaging of spine
102/112
102
-
8/10/2019 medical imaging of spine
103/112
103
-
8/10/2019 medical imaging of spine
104/112
104
At level L4L5
-
8/10/2019 medical imaging of spine
105/112
105
-
8/10/2019 medical imaging of spine
106/112
106
-
8/10/2019 medical imaging of spine
107/112
107
-
8/10/2019 medical imaging of spine
108/112
108
-
8/10/2019 medical imaging of spine
109/112
-
8/10/2019 medical imaging of spine
110/112
110
Left: T2w image; Right T1w image:
-
Anterolisthesis of L3 on L4
-
Hypertrophic ligamenta flava
As a consequence the spinal canal is narrowed at the L3L4 level.
-
8/10/2019 medical imaging of spine
111/112
111
MR myelogram: spinal canal stenosis: narrowed CSF spaces.
-
8/10/2019 medical imaging of spine
112/112