Fifth Stage
Diagnostic Imaging
Dr. Firas A. – Lecture 4
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Spine imaging
Aims of our lecture:
To know the different radiological techniques used in spine imaging
To know the signs of abnormality seen at spine
To discuss some spinal pathologies
I) Radiological techniques used in spine imaging:
Plain X ray
MRI
Radionuclide bone scanning
CT scan
Myelography
Plain X ray
Fifth Stage
Diagnostic Imaging
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MRI
II) Signs of abnormality:
Disc space narrowing:
Collapse of vertebral bodies: most easily appreciated on plain lateral radiographs
of the spine, look to the adjacent disc and pedicle. Common causes include:
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Metastases and myeloma.
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Infection
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Osteoporosis and osteomalacia
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Trauma
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Eosinophil granuloma: vertebra plana
Pedicles:
Dense vertebrae:
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Metastases‚
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Malignant lymphoma.
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Paget’s disease
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Hemangioma
Lysis within a vertebra: metastasis, MM, infection, lymphoma.
Paravertebral shadow
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Diagnostic Imaging
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Fifth Stage
Diagnostic Imaging
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III) Pathologies:
Metastasis, multiple myeloma, lymphoma:
Metastasis can involve the pedicle, as well as vertebral body.
Collapse occur in all.
Intervertebral disc.
Radionuclide imaging
MRI
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Diagnostic Imaging
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Infection:
IVD, end plates destruction, body.
Pyogenic or TB
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Spinal trauma:
Plain films are the initial investigation for trauma
CT is indicated in patients with a high risk of spinal injury or
with a neurological deficit.
In the unconscious patient with a head injury, CT of the cervical
spine is carried out at the same time as a head CT
MRI: spinal cord injury, hematoma, disc bulge
Jefferson fracture: fractures of the lateral masses of C1.
hangman’s fracture: fracture of the arch of C2.
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Diagnostic Imaging
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Degenerative disc disease
Spondylosis occurs maximally in the lower cervical and lower
lumbar regions.
Plain film signs: disc space narrowing, osteophytes, sclerosis.
MRI: IVD shows loss of height, reduced hydration (low T2). Disc
bulge or protrusion.
Spinal canal stenosis.
Ankylosing spondylitis
Affects principally the sacroiliac joints and the spine
The earliest radiological change is fuzziness of the joint
margins, followed by frank erosions. Eventually, the process
leads to obliteration of the joint space.
Syndesmophytes.
In advanced cases, the whole spine is rigidly fused and
becomes a solid block of bone. Known as a ‘bamboo spine’.
Fifth Stage
Diagnostic Imaging
Dr. Firas A. – Lecture 4
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Spondylolisthesis:
Forward slip of one vertebral body on the one below.
Occurs most frequently at the lumbosacral junction and
between L4 and L5 vertebral bodies.
The defect in the pars interarticularis is thought to be a stress
fracture which can usually be identified on the lateral
projection.
Spondylolysis: is the term given to a defect in the pars
interarticularis without a forward slip of one vertebral body on
the other.
Thank You,,,