19. Spine and spinal cord - Imaging technique

Question 1

Overview:

Answer 1

Degenerative diseases, trauma, infections, tumors, congenital anomalies

Question 2

MRI:

Answer 2

Purpose: primary imaging for detailed assessment
Spinal cord + intervertebral discs+ soft tissue

Sequences:
T1w: anatomical detail, vertebral body marrow, soft tissues
T2w: water content, edema, inflammation, CSF spaces
STIR: suppress fat signal, highlights edema/inflammation
Contrast-Gd: tumors, infections, vascular anomalies

Applications:
Degenerative disc disease, spinal cord tumors, inflammatory conditions (MS), spinal infections, trauma (SC contusion), congenital anomalies

Question 3

CT:

Answer 3

Purpose: bony structures (trauma)

Techniques:
CT myelography: intrathecal CONTRAST and CT for SC + nerve roots
CT with 3D: surgery planning

Applications:
Acute trauma (fractures/dislocation)
Degenerative bone diseases
Spinal stenosis
Surgery planning/evaluation

Question 4

X-ray (radiography): initial method

Answer 4

Purpose: spinal structure, fractures, gross degenerative changes

Techniques: AP, lateral, oblique

Applications:
Trauma (initial evaluation)
Degenerative disc disease
Scoliosis/spinal deformities
Vertebral arrangement

Question 5

Ultrasound:

Answer 5

Purpose: limited in adults (poor penetration of bone), useful in pediatric (soft tissue assessment)

Applications:
Neonatal incomplete fusion
Soft tissue masses/abscesses
Guidance for injection/biopsy

Question 6

Nuclear medicine:

Answer 6

Purpose: functional imaging of spine, metabolic activity + tumors + infections

Techniques:
Bone scintigraphy: technetium-99m for areas of increased bone turnover
PET: often PET/CT for metabolic activity of spinal tumors/infections