Post on 30-Mar-2021
Introduction to
Neuroimaging
spine
John J. McCormick MD
Neuroanatomy
Netter drawings
Radiographic Anatomy
Cervical Spine
Cervical Spine
Oblique View
Cervical Spine
Dens View
Thoracic Spine
Lumbar Spine
MRI Anatomy
Spine Pathology
• Trauma
• Degenerative disease
• Tumors and other masses
• Inflammation and infection
• Vascular disorders
• Congenital anomalies
Evaluating Trauma
• Fracture
• Dislocation
• Ligamentous injury
• Cord injury
• Nerve root avulsion
Plain films may be very subtle or
absent
• 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.
• Burst fracture
Tumors and Other Masses
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
Common Extradural Lesions
• Herniated disc
• Vertebral hemangioma
• Vertebral metastasis
• Epidural abscess or hematoma
• Synovial cyst
• Nerve sheath tumor
– Neurofibroma
– Schwannoma
Common Intradural Extramedullary
Lesions
• Nerve sheath tumor (also extradural)
• Meningioma
• Drop Metastasis
Common Intramedullary Lesions
• Astrocytoma
• Ependymoma
• Hemangioblastoma
• Cavernoma
• Syrinx
• Demyelinating lesion (MS)
• Myelitis
Extradural: Herniated disc
Extradural: Hemangioma
Extradural: Vertebral Metastasis
Extradural: Epidural Abscess
Extradural Meningioma
Intradural Extramedullary:
Meningioma
Intradural extramedullary
Intrradural Extramedullary:
Neurofibroma
Intradural Extramedullary:
“Drop Mets”
Endolymphatic Sac
Intradural Extramedullary:
Arachnoid Cyst
Intramedullary: Astrocytoma
Astrocytoma with Syrinx
Hydromyelia
Intramedullary: Syringohydromyelia
• Seen with:
– Congenital lesions
chiari I & II
tethered cord
– Aquired lesions
trauma
tumors
arachnoiditis
– Idiopathic
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
Infection and Inflammation
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
Pyogenic Spondylitis / Diskitis with
Epidural Abscess
Acute Osteoporosis Compression
• May look similar to pyogenic infection
• Clinical context
Spinal TB (Pott’s Disease)
• Prominent bone
destruction
• More indolent onset
than pyogenic
• Gibbus deformity
• Involvement of
several VB’s
Transverse Myelitis
• Inflamed cord of uncertain cause – Viral infections
– Immune reactions
– Idiopathic
• Myelogathy progressing over hours to weeks
• DD: MS, glioma, infarction
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
Cord Edema
• May be secondary to
ischemia (eg embolus
to spinal artery)
• Venous hypertension
(eg AV fistula)
• Aortic aneurysm
Congenital