MRI of acute spinal trauma

SHIVAPRAKASH.B.H2nd yr RESIDENT

BARNARD INSTITUTE OF RADIOLOGY

To describe various components of spinal injuries on MRI.

To know whether mechanism of injury can be assessed by pattern of injury.

AIM

Anatomy Approach Mechanism of injury

Normal anatomy - Axial

Vertebral body level

Normal anatomy - Axial

Intervertebral disc level

Sagittal

Normal anatomy - Parasagittal

Dennis 3 Column concept

Sections Sequences

Sagittal T1W SE,T2W FSE

Axial T1W SE,T2W FSE

Imaging protocol

Sequences SignificanceFat sat T2W/STIR BONY EDEMA &

INJURY TO INTERSPINOUS LIG

T2W GRE CORD HEMATOMA

Malalignment in sagittal plane, Change in vertebral body contour.

Vertebral injury

To look for It implies

Break in the continuity of the signal void

Vertebral cortex injury

Signal change Haemorrhage and oedema within the vertebral body

Wedge compression injuries

Bands of hyperintensity on T2-weighted images parallel to the end-plate,

Fracture of the superior end-plate,

Buckling of the anterior vertebral body cortex.

D12 wedge compression #

Burst fractures Associated

disruption of the posterior vertebral body cortex.

D12 burst #

Sectional plane To look for

Parasagittal Subluxation and dislocation of the facet joints

Axial images Fractures of the neural arch

C6 – C7 IVD

C7

Anterior longitudinal (ALL), Posterior longitudinal (PLL) and Posterior ligamentous complex (PLC) comprising the ligamentum flavum. (LF), interspinous ligament (ISL),

supraspinous ligament (SSL) and facet joint capsules.

Ligaments of the spine

Rupture Discontinuity of the ligament, Stripping of the intact ligament, Partial avulsion or attenuation of the

ligament and combined osseo-ligamentous injury.

Best identified on T2-weighted images.

Ligament injuries

D11 over D12

D 11 fracture D12 wedge compression #

Intradiscal haemorrhage/oedema, Annular rupture, Avulsion from the end-plate and herniation,

either into the epidural space or into the vertebral body.

Disc injury

D12 #

D11 over D12

Type On T1W On T2W

Type 1 (Intramedullary hematoma)

Depends on age Depends on age

Type 2 (Cord edema)

Diffuse swelling of cord

Diffuse hyperintensity of cord

Type 3 (Mixed lesion)

Small central hypointensity surrounded by flame shaped areas of oedema

Neural injury

Cord hematoma

C5-C6,C7-C8 IVD levels

Cord edema

Transection

C5 over C6

D10 over D11

Focal kyphosis, Abnormal separation of facets/spinous

processes. Evidence of canal compromise and ventral

cord edema.

Hyperflexion injury

C4 over C5

Soft tissue edema in post spinal soft tissue. Edema and disruption of ALL and nuchal

ligament injury.

Hyperextension injuries

C5 over C6

Altered adjacent facetal relationship. Spinous process malalignment. Focal vertebral body kyphosis.

Hyperflexion rotation injury

A perched facet joint, is a vertebral facet joint whose inferior articular process on one side appears to sit 'perched' on the superior articular process of the vertebra below.

Perched facet

Locked facet

Unilateral facet or laminar fracture due to hyperextension with rotation combined causing ligament disruption.

Hyperextension rotation injury

C7

Mimics

MRI is best for assessment of the patient with acute spinal injury.

Careful attention to technique and imaging allows us to complete evaluation of injury to the vertebral column, ligaments, discs and cord.

The array of findings associated with mode of spinal injury allows us conclude about mechanism of injury to spine.

To conclude

Thank you