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Dr. Sajjad Hussain Faculty in Neuroradiology Department of Radiology and Medical Imaging

SPINAL CORD. Dr. Sajjad Hussain Faculty in Neuroradiology Department of Radiology and Medical Imaging King Saud University / King Khalid University Hospital. Imaging Methods to Evaluate Spine Plain X-Ray Films - bones

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Dr. Sajjad Hussain Faculty in Neuroradiology Department of Radiology and Medical Imaging

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  1. SPINAL CORD Dr. Sajjad Hussain Faculty in Neuroradiology Department of Radiology and Medical Imaging King Saud University / King Khalid University Hospital

  2. Imaging Methods to Evaluate Spine • Plain X-Ray Films - bones • Myelogram – injection of contrast medium in CSF followed by x-ray images. Rarely performed now-a-days • Computed Tomography (CT Scan) • Magnetic Resonance Imaging (MRI) • Spinal angiography – to evaluate arteries and veins • Ultrasound – more in children • Radionuclide Bone Scan – intravenous injection of radioactive material bound to phosphonates which deposit in bones, followed by images by gamma camera. • DEXA – radionuclide scan for bone density (osteoporosis)

  3. X-RAYS (RADIOGRAPHS) Often the first diagnostic imaging test, quick and cheap Small dose of radiation to visualize the bony parts of the spine Can detect Spinal alignment and curvature Spinal instability – with flexion and extension views Congenital (birth) defects of spinal column Fractures caused by trauma Moderate osteoporosis (loss of calcium from the bone) Infections Tumors May be taken in different positions (ie; bending forward and backward) to assess for instability

  4. COMPUTERIZED TOMOGRAPHY (CT SCAN) Uses radiation Obtain 2-D images  can be processed to 3-D images Patients lies on a table that moves through a scanner Much detailed information regarding bony structures Limited information about spinal cord & soft tissues Entire spine can be imaged within a few minutes

  5. CT SCAN

  6. Magnetic Resonance Imaging (MRI) Gold standard of imaging for spinal cord disorders No radiation Can identify abnormalities of bone, soft tissues and spinal cord Patient lies still on a table that moves through a tunnel like structure Takes about 15 - 25 minutes Claustrophobic patients, uncooperative / semiconscious patients, and children may need sedation or general anesthesia Contraindications include implanted devices e.g. cardiac pacemakers, electromagnetic devices, certain metal clips and stimulators Artificial joints and other fixed metals  no problem

  7. MRI SCANNER

  8. MR images are multi-planar

  9. MR images are very high resolution

  10. MR images are very high resolution

  11. Abnormalities of spinal cord Congenital Trauma Demyelination Tumors Ischemia

  12. Congenital

  13. Antenatal US Antenatal MRI

  14. Trauma

  15. 24 years old with paraplegia after road traffic accident since 3 years

  16. Hyperflexion fx with ligamentous disruption and cord contusion

  17. Vertebral Artery Dissection/Occlusion Secondary to C6 Fracture

  18. Tumors

  19. AJNR

  20. Astrocytoma

  21. Astrocytoma

  22. Ependymoma

  23. Cord Edema As in the brain, may be secondary to ischemia (e.g. embolus to spinal artery) or venous hypertension (e.g. AV fistula)

  24. Transverse Myelitis Inflamed cord of uncertain cause Viral infections Immune reactions Idiopathic Myelopathy progressing over hours to weeks DDX: MS, glioma, infarction

  25. Multiple Sclerosis Inflammatory demyelination eventually leading to gliosis and axonal loss T2-hyperintense lesion(s) in cord parenchyma Typically no cord expansion (vs. tumor); chronic lesion may show atrophy

  26. Key Points for MS, Transverse myelitis, and ADEM MS lesions in spinal cord are more likely multiple, focal and peripherally located don’t cover the entire section on axial images often < 2 vertebral body heights on sagittal images are disseminated in time and space may enhance in acute phase Transverse myelitis lesions extend over >3 vertebral body heights on axial images often > 4 vertebral body heights on sagittal images no brain lesions ADEM and NMO lesions in spinal cord – similar but presence of Brain lesions  ADEM Optic nerve lesions  NMO

  27. SYRINGOHYDROMYELIA Seen with: • congenital lesions • Chiari I & II • tethered cord • acquired lesions • trauma • tumors • arachnoiditis • idiopathic

  28. SYRINX On imaging, a syrinx is a longitudinally oriented CSF-filled cavity with surrounding myelomalacia / gliosis may have a beaded or cystic expansile configuration

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