introduction to neuroimaging spine · spine pathology •trauma •degenerative disease •tumors...
TRANSCRIPT
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Introduction to
Neuroimaging
spine
John J. McCormick MD
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Neuroanatomy
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Netter drawings
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Radiographic Anatomy
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Cervical Spine
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Cervical Spine
Oblique View
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Cervical Spine
Dens View
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Thoracic Spine
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Lumbar Spine
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MRI Anatomy
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Spine Pathology
• Trauma
• Degenerative disease
• Tumors and other masses
• Inflammation and infection
• Vascular disorders
• Congenital anomalies
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Evaluating Trauma
• Fracture
• Dislocation
• Ligamentous injury
• Cord injury
• Nerve root avulsion
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Plain films may be very subtle or
absent
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• A 28 year old man who was 5 feet 9 inches and 16 stone was playing rugby as a number 8. He ran head first into a tackle, causing an axial compression injury to his neck. This caused immediate, dull pain over the whole of his neck. He attempted to continue playing but found that merely running exacerbated the pain considerably. He later noticed the pain localising to the whole axial area along with his head “feeling heavy and loose”. He self treated with a soft collar for two days, before presenting to the accident and emergency (A&E) department, by which time the pain was persistent in the sub-occipital area. At no stage did he have any neurological symptoms.
• Examination showed painful neck movements, with pronounced reduction of range in all directions.
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• Burst fracture
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Tumors and Other Masses
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Classification of Spinal Lesions
• Extradural: outside the thecal sac
(including vertebral bone lesions)
• Intradural/ extramedullary: within the
thecal sac but outside cord
• Intramedullary: within cord
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Common Extradural Lesions
• Herniated disc
• Vertebral hemangioma
• Vertebral metastasis
• Epidural abscess or hematoma
• Synovial cyst
• Nerve sheath tumor
– Neurofibroma
– Schwannoma
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Common Intradural Extramedullary
Lesions
• Nerve sheath tumor (also extradural)
• Meningioma
• Drop Metastasis
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Common Intramedullary Lesions
• Astrocytoma
• Ependymoma
• Hemangioblastoma
• Cavernoma
• Syrinx
• Demyelinating lesion (MS)
• Myelitis
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Extradural: Herniated disc
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Extradural: Hemangioma
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Extradural: Vertebral Metastasis
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Extradural: Epidural Abscess
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Extradural Meningioma
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Intradural Extramedullary:
Meningioma
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Intradural extramedullary
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Intrradural Extramedullary:
Neurofibroma
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Intradural Extramedullary:
“Drop Mets”
Endolymphatic Sac
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Intradural Extramedullary:
Arachnoid Cyst
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Intramedullary: Astrocytoma
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Astrocytoma with Syrinx
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Hydromyelia
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Intramedullary: Syringohydromyelia
• Seen with:
– Congenital lesions
chiari I & II
tethered cord
– Aquired lesions
trauma
tumors
arachnoiditis
– Idiopathic
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Confusing “Syrinx” Terminology
• Hydromyelia: Fluid accumulation/dilatation within central canal, therefore lined by ependyma
• Syringomyelia: Cavitary lesion within cord parenchyma, of any cause. Located adjacent to central canal, therefore not lined by ependyma
• Syringohydromyelia: Term used for either of the above, since the two may overlap and cannot be discriminated on imaging
• Hydrosyringomyelia: Same as syringohydromyelia
• Syrinx: Common term for the cavity in all of the above
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Infection and Inflammation
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Infectious Spondylitis/ Diskitis
• Common chain of events (bacterial
spondylitis):
– Hematogenous seeding of subchondral VB
– Spread to disc and adjacent VB
– Spread into epidural space
– Spread into paraspinal tissues
– May lead to cord abscess
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Pyogenic Spondylitis / Diskitis with
Epidural Abscess
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Acute Osteoporosis Compression
• May look similar to pyogenic infection
• Clinical context
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Spinal TB (Pott’s Disease)
• Prominent bone
destruction
• More indolent onset
than pyogenic
• Gibbus deformity
• Involvement of
several VB’s
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Transverse Myelitis
• Inflamed cord of uncertain cause – Viral infections
– Immune reactions
– Idiopathic
• Myelogathy progressing over hours to weeks
• DD: MS, glioma, infarction
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Multiple Sclerosis
• Inflammatory
demyelination eventually
leading to gliosis and
axonal loss
• T2 hyperintense lesions
in cord parenchyma
• Typically no cord
expansion (vs. tumor);
chronic lesion may show
atrophy
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Cord Edema
• May be secondary to
ischemia (eg embolus
to spinal artery)
• Venous hypertension
(eg AV fistula)
• Aortic aneurysm
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Congenital