advanced cross-sectional imaging of spinal injuries...spinal injury imaging choices •plain films...
TRANSCRIPT
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Advanced Cross-Sectional Imaging of Spinal Injuries
Kishan Yalavarthi M.D. Neuroradiology
Center for Diagnostic Imaging (CDI) St.Luke’s Hospital
St. Louis, MO
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Spinal Injury Imaging Choices
• Plain Films
• MRI
– With or without contrast
- Closed MRI, Open MRI, Open Upright MRI
• CT
– without contrast
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Plain Films
• Lumbar radiographs sufficient for the INITIAL evaluation of the following:
– Recent significant trauma (at any age)
– Osteoporosis
– Age >70
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Normal 2 view L-Spine
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Normal 3 view T-Spine
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Fall with Fracture/Subluxation
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Plain Films
Advantages
• Fast Study (2-3 seconds)
• Quick Survey(Order 2-View)
• Inexpensive
• No contraindications
• Limited Radiation Dose
Disadvantages
• Only evaluates bones
• May not detect subtle fractures
• Small amount of radiation
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MRI
• Invented in 1971, but took many years before it became clinically viable
• Images obtained within a strong magnetic field using the properties of hydrogen within tissue
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MRI – Closed Bore
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MRI – Open Bore
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MRI – Indications in complicated Back Pain
• Order without contrast:
– High suspicion for compression fracture
– Radiculopathy, nerve, or spinal cord compression
– Cauda Equina Syndrome
• Order WITH and without contrast:
– History of Cancer, infection, or immunosuppresion
– Prior Lumbar Surgery
• Gadolinium FDA warning (GFR<30)
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MRI – Contraindications
• Pacemaker/Defibrillator
• Certain aneurysm clips, neural stimulator devices
• Metallic Foreign Bodies in orbits
• Infusion/Insulin Pumps
• 1st Trimester Pregnancy
• Severe claustrophobia
• Morbid obesity
• Call to speak with our Chief MR Tech or one of the Neuroradiologists with questions about patient safety
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Fall with Fracture/Subluxation
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Fall with Fracture/Subluxation
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Weightlifting injury with Pedicle Fracture Not Visible on Plain Film
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Recent Fall, Back pain
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Recent Fall, Back pain
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Recent Fall, Back pain
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Pt. with lifting injury at work with lumbar radiculopathy
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Previous Lumbar Surgery in recent MVA, now with recurrent pain
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• Hx of MVA 3 years earlier
• Persistent neck pain, and upper extremity numbness/tingling
• Comparison plain films from that date demonstrated instability at C5-6
• Open Upright MRI requested with flexion/extension views
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54 y.o. female w/ neck & back pain & HA post-MVA
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Pt. With fall, back pain and numbness, unable to lay flat due to kyphosis
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MRI
Advantages
• No Radiation
• Excellent Soft Tissue, Spinal Canal and Cord Detail
• Sensitive for Edema
• Detects other lesions –cysts, tumors, etc.
• Can use non-iodinated contrast – diskitis
• Vertebroplasty Planning
Disadvantages
• Length of scan - 30-45 minutes
• Claustrophobia
• Weight limit
• Painful position- must lay flat and still for a prolonged time.
• Last 3 disadvantages reduced with open MRI and Open Upright MRI
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CT
• Computed Tomography: – Large series of two-dimensional x-ray images taken
around a single axis of rotation
• No IV contrast needed for spine studies • Best Indications:
– Patients unable to have MRI – Quick Evaluation of Acute Trauma(ER) – Evaluate Fusion Bone post surgery
• Contraindications – Pregnancy
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CT
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Pt. with acute back pain post trauma, with pacemaker
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Ankylosing Spondylitis with acute injury and pain
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CT
Advantages
• Fast (30 sec.)
• Reconstructions- Sag./Cor.
• Excellent Bone Detail
• Surgical Planning
• Larger bore size than MRI
• No Contraindications for Metal Device(Pacers,etc)
Disadvantages
• Radiation Dose (10 mSv)
• Weight limits
• Disk and Soft Tissue Detail less than MRI
• Cannot evaluate Cord
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Questions/Comments?
• Made CT and MR schedules accomodating to allow many add-ons during the day
• For questions: • http://www.mycdi.com/missouri/locations__services/
• 314-567-9729
• Kishan Yalavarthi M.D.