spine / spinal cord - radiologia · pdf filespine & spinal cord imaging methodology ......
TRANSCRIPT
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Neuroimaging
spine / spinal cord
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Spine & spinal cord
imaging methodology
Plain x-ray of spine
Computed tomography – CT- traditional („normal” CT)
- reconstructions
- myelo-CT
Magnetic resonance – MR- standard techniques
Angiography - DSA
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Cervical spine x-ray
post-traumatic injuries & degenerative disorders
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Lumbar spine x-ray
post-traumatic injuries & degenerative disorders
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Myelography – is a history
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CT was a great progress in spine and spinal cord imaging
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Myelo-CT
was very important before - MRI came to clinical practice
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Nowadays CT
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Spine MRI spinal canal / spinal cord
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Spine MRI – spinal nerves
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1. Congenital spine & spinal cord defects
developmental anomalies
heterogenic group of disorders
selected exaples below
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cervical vertebral bodies
in block
os odontoideum
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Meningeal Cysts
(Tarlow cysts)
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Meningeal hernia
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Hydromyelia
Syringomyelia
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Captured spinal cordcombined anomaly
- ”spina bifida”
- Tarlow cyst
- broadened terminal filament
- no conus of spinal cord
- fibro-lipoma in spinal canal
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2. Demyelinization diseases
multiple sclerosisM S
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Spinal cord demyelinization
MS
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MS
plaques in cervical spinal cord
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Focal lesion in cervical spinal cord
demyelinization or tumor (neoplasm) ?
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3. Spinal canal tumors
extra meningeal
intra-meningeal, extra-medullary
intra-medullary (intra-axial)
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Spinal canal tumors extra-meningeal
benign: neurinoma, osteoma, fibroma, lipoma
malignant: osteo - & chondrosarcoma, chordoma, lymphoma
metastases
Fibrolipoma
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Spinal canal tumors extra-meningeal
neurinoma (schwannoma)
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Spinal canal tumors intra-meningeal / extra-medullary
naurinoma, neurofibroma
meningioma
lipoma, teratoma (seldom)
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neurinoma ‘dumbbell tumor’
Spinal canal tumors intra-meningeal / extra-medullary
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Intra-medullary tumors astrocytoma (most frequent)
ependymoma, hemangioma
metastases
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Intra-medullary tumors (intra-axial)
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Intra-medullaryependymoma
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Vertebral spine and spinal canal metastases
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Spinal cord hemangioma
intra-medullary focal lesion – „nidus”
pathologic vessels in spinal canal (intra-meningeal)
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4. Degenarative spinal disease
discopathy
bone degeneration
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Intervertebral disc prolapsus
with spinal nerve compression
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L-S discopathy L4-L5 & L5-S1 levels
massive left-side disc protrusion L5-S1
spinal nerve compression
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Intervertebral disc protrusion - MRfrom I to IV degree
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Intervertebral disc sequestrationprolaps of a disc to spinal canal
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Spinal canal stenosis
discopathy coexisting with
bone degeneration (ostephyte)
spinal nerve compression
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Spine degenerative disease - complications
inflamed process
in vertebral bodies border laminas
spondylodiscitis
non-stability
L5 vertebral body slide down
spondylolisthesis
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Dyscopathy – recurrent after operation
contrast enhencement
after paramagnetic administration
connective tisue scar
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Cervical spine discopathyspinal canal stenosis C5-C7
- meninges and spinal cord compression
- stenosis of right intervertebral foramen
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Chronic spinal cord compression
- focal gliosis at the level of compression
- central canal of a cord broadening
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5. Spine & spinal cord injuries
solitare spinal fractures
injuries with spinal cord compression
pathologic fractures
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Spine injuries
compressive fracture of vertebral body – one of the most frequent?
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compressive fracture
of vertebral body
CT in 3 dimentions
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Spine injuries
compressive fracture of vertebral body
not ”very harmful”
when stabile & does not affect neurostructures
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Spine and spinal cord injuriesvertebral body compressive fracture with spinal cord compression
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Chance fracture
spinal cord compression
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Spine and spinal cord injuries
- pathologic fracture of vertebral body (meta)
- compression of spinal cord conus
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Spine and spinal cord injuries
pathologic fracture of vertebral body (osteoporosis)
hardly seen on plain x-ray films
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Cervical spinal cord injury
most frequent - ”water jump”
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Cervical spinal cord injury
whiplash mechanism or rear-end MVA
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”skull base fracture”
fracture of dens axis