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