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