jalal jalal shokouhi-md general secretary of iranian society of radiology ...

SPINAL CORD M.SSPINAL CORD M.S..

Jalal Jalal Shokouhi-MDGeneral secretary of Iranian society of Radiology

www.medimage.ir jalaljalalshokouhi@hotmail.com

www.medimage.ir jalaljalalshokouhi@hotmail.com

Age is the same as brain MS (18-50,95% in 30-40)

Female>Male

Commonly involved 97% of known cases (50% in C-cord).

Shape is focal, confluent or entire cord length.

30%-40% of plaques could be asymptomatic.

All level could be involved (50% in C-cord).

2

3

4

5

6

7

Lateral and Posterior aspects of the cord adjacent pia.

Plaque signal is the same as brain.

Mild cord expansion due to swelling and edema.

Acute phase shows enhancement by GD (T1,Flair or T1 STIR)

8

9

10

Diffuse lessions are primary, secondary progressive Focal plaques are relapsing-remitting subtype Cord atrophy (18%) chronic M.S.

• Primary lesions• Axonal degeneration from distal disease

11

12

13

14

15

1) Routine in M.S. signs

2) Early diagnosis

3) Rule out clinical mimics

4) To predict prognosis(short and long term)

5) To monitor treatment

6) To monitor treatment complications

Conventional MRI is for:Conventional MRI is for:

16

MRI detection (86%) Intermediate to T2 weighted (PDW, T2) T1 correlated better with microscopic (PDW & T2 are not) T1 Cellular infiltration and edema T1 finding correlation with clinic is important T2 shows watery changes Fast STIR, fast spine T2 T2* , Fat Sat. images MT: magnetization transfer measurements specially in brain

diffuse M.S. Post processing of MR images

17

18

19

20

non-uniform intensity in all images specially by surface coils in C-cord imaging (A bias)

Post processing of MR images(TR, TE,Tissue)

1) Uniformity correction

2) Registration for image analysis

3) Image segmentation (sets of pixels)

4) Measurement of lesion volumes

5) Atrophy diagnosis

6) Magnetization transfer (assessing proton of macromolecules)

“MTR” (Cell membrane and myelin)

Exchanging magnetization between mobile protons and fix

ones in macromolecules

21

7) Least-squares fitting and relaxometry or calculated MTR is a quantitative assessment of tissue damage (T1,T2,T2*=R1,R2,R2*)

8) Diffusion tensor imaging (DTI), tractography(EPI)(Echo-planar imaging) DW images (DTI is a 3D DW)

9) Perfusion (abnormal CBF cerebral blood flow in M.S.)

10) 3D anatomo-functional composite image as data handling

22

23

24

25

26

27

Thank you for your attention

28