Spine / spinal cord - radiologia

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 cord
combined anomaly
- broadened terminal filament
- no conus of spinal cord
- fibro-lipoma in spinal canal
- ”spina bifida”
- Tarlow cyst
2. Demyelinization diseases
multiple sclerosis
MS
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
neurinoma (schwannoma)
extra-meningeal
Spinal canal tumors
 naurinoma, neurofibroma
 meningioma
 lipoma, teratoma (seldom)
intra-meningeal / extra-medullary
Spinal canal tumors
intra-meningeal / extra-medullary
neurinoma
”hour-glass tumor”
Intra-medullary tumors
 astrocytoma (most frequent)
 ependymoma, hemangioma
 metastases
Intra-medullary tumors
(intra-axial)
Intra-medullary
ependymoma
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 - MR
from I to IV degree
Intervertebral disc sequestration
prolaps 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
Dyscopathy – recurrent after operation
contrast enhencement
after paramagnetic administration
connective tisue scar
Cervical spine discopathy
spinal 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 injuries
vertebral 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