ميحرلا نمحرلا الله مسبNo Post- operative lumbar spine Inflammatory and neoplastic...
Transcript of ميحرلا نمحرلا الله مسبNo Post- operative lumbar spine Inflammatory and neoplastic...
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بسم هللا الرحمن الرحيم سبحانك ال علم لنا اال ماعلمتنا انك انت العليم الحكيم
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Technique Supine position
Scanogram [frontal, lateral]
Scan intervals
Fasting 4- 6 hours Contrast material [Urographin,Telebrix,..]1-2 ml/kg
Anesthesia Children, Uncooperative patients
Patient Preparation
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No
Post- operative lumbar spine
Inflammatory and neoplastic lesions
Any other pathology [disc lesions,
spinal trauma, congenital anomalies
Yes
Contrast administration
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Computed Tomography
Axial sections 2-4mm
Bone +soft tissue window
Contrast injection [urographin , telebrix,..] • post operative spine
• Inflammatory and neoplastic lesions
1
2
3
4
5
Scanning for disc lesions
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1
2
3
4
5
Screening 5-8mm segment of spine [dorsal, lumbar,…]
Selective scanning 3mm trauma [focus on affected vertebra]
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2D and 3D
Images
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Bone and soft tissue
windows
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Intrathecal contrast injection [Omnipaque 240mg I/ml] Followed by CT
CT Myelography
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CT Myelography
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CTM versus MRI
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Spinal canal diameter[ lumbar]
Disc lesions
Others
• Joints[ facet, neuro central, sacroiliac]
• Para vertebral soft tissues
D=1.6
Items for evaluation
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L5
1.4 cm
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Disc
lesions
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L3-4 L5-S1
L1-2
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L5-S1
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L5-S1 L5-S1 L5-S1
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L5-S1 L5-S1
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L5-S1
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L5-S1 L5-S1
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L2-
3
L3-
4
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L3-
4
Facet joints
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L3-
4
Facet joints
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Neurocentral joints
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Cervical discs
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C6-
7
C5-
6
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Neurocentral & facet Joints
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MRI Open
MRI Closed
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Extremity MRI
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The bed rotates from Upright to Recumbent, stopping at any angle in between
Dynamic MRI
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N
O !
Does a Lie-Down-Only Scanner see the patient’s problem ?
Patient with Low Back Pain After Surgery
Case courtesy of M. Rose, MD, Rose Radiology Centers
Dynamic MRI
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Dynamic MRI
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Surface coils
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Axial, Sagittal Coronal Others
4mm thickness
No interslice gap
Contrast injection similar to CT[ Gd- DTPA]
T1 CSF black
T2 CSF white
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CT MRI
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• Sagittal T1
• Sagittal T2
• Axial T1
• Axial T2
• Coronal T1 or T2
[optional]
MRI protocol
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Scoliotic deformity
Paraspinal soft tissue
Extension of intraspinal pathology
Coronal images
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Coronal images
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Spinal canal [cervical and lumbar]
Intervertebral discs
Paravertebral soft tissues
Others [ Specific for MRI]
• Spinal cord, conus
• Bone marrow
Items for evaluation
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Lumbar
Spinal canal
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Capacious lumbar spinal canal
21
mm
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Cervical
Spinal canal
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Cervical
Spinal canal
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Normal lumbar discs
S1
L5
L4
L3
T2 T2
T1
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Normal cervical
discs
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Normal bone marrow [ fat signal
]
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Normal spinal cord and
cauda equina
Intermediate signal in T1 and T2 [ brain]
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Hemorrhage, bone fragments,…[ Trauma]
Abscesses [inflammatory lesions]
Neoplastic extra osseous masses [ Tumors]
Para-vertebral shadows
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Mamdouh mahfouz MD [email protected]
نستغفرك و نتوب اليك ×نشهد ان ال اله اال انت ×سبحانك اللهم و بحمدك
Thank you ssr-eg.net
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Normal,4
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Metallic artifacts+ normal+bone sclerosis
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disc spondylolisthesis
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Spinal Radiographs AP, lateral, oblique views
Alignment [lordosis, kyphosis, straightening]
Bony texture [ normal, osteoporosis,…]
Disc spaces [maintained, narrow,…]
Others
• Cervical ribs [cervical spine]
• Paravertebral shadows [dorsal spine]
• Sarcoiliac joints [lumbar spine]
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R
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Normal,4