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FRCR 2A (Crack The FRCR 2A) > 6. Neuro (Spine) > Flashcards

6. Neuro (Spine) Flashcards

1
Q

Spinal cord blood supply (8)

A

Anterior and posterior blood supply, both affected by different clinical syndromes.
Anterior spinal artery:
- arises bilaterally as 2 small branches at the level of the termination of the vertebral arteries.
- These 2 arteries join at the level of the foramen magnum
Artery of Adamkiewicz
- Most notable reinforcer of the anterior spinal artery.
- In 75% of people, it comes off the left side between T8 and L1.
- Supplies lower 2/3 of cord.
- Can get covered with placement of endovascular stent graft for aneurysm of dissection, leading to spinal infarct.
Posterior spinal artery
- Arises from either the bertebral arteries or the posterior inferior cerebellar artery
- Unlike the anterior spinal artery, this one is discontinuous and reinforced by multiple segmental or radiculopial branches.

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2
Q

Conus medulliaris (2)

A

Terminal end of the spinal cord.
Usually terminates at L1, below the inferior endplate of L2/3 should be sus for tethered cord.

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3
Q

Which nerve is compressed (5)

A

Other than C8 nerve, each pair of spinal nerves corresponds to a vertebra.
More than 90% of disc herniations occur at L4-5 and L5-S1.
At the L5-S1 disc:
- Foraminal disc will affect the exiting nerve, in this case L5.
- Central or Paracentral disc will affect the descending nerve, in this case S1

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4
Q

Epidural fat (3)

A

Epidural fat is not evenly distributed.
Epidural space in the cervical cord is predominantly filled with venous plexus (as opposed to fat).
In the lumbar spine, there is fat both anterior and posterior cord.

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5
Q

Spinal stenosis (5)

A

Can be congenital (associated with short pedicles) or acquired.
The Torg-Pavlov ratio can be used to diagnose (vertebra body width to cervical canal diameter <0.85).
Symptomatic stensosis is more common in the cervical spine (vs thoracic or lumbar).
Can get some congenital stenosis in lumbar due to short pedicles, but generally not symptomatic until middle age.

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6
Q

Disc nomenclature (5)

A

Focal herniation - herniated disc comprising less than 90 degrees of the disc circumference
Broad based herniation is a herniated disc between 90-180 degrees.
Protrusion is term used when distance between edge of the disc herniation is less than the distance between the edges of the base.
Extrusion is term used when edges of the disc are greater than the distance of the base.

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7
Q

Schmorl’s node (2)

A

Herniation of disc material through a defect in the vertebral body endplate, into the actual marrow.

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7
Q

Limbus vertebra (2)

A

Fracture mimic.
Result of herniated disc material between the non-fused apophysis and adjacent vertebral body

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7
Q

Scheuermann’s (2)

A

Multiple levels (at lest 3) of Schmorl’s nodes in the spine of a teenager, resulting in kyphotic deformity (40 degrees in thoracic or 30 degrees in thoracolumbar)

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8
Q

Enplate changes (5)

A

Commonly referred to as modic changes.
Progression in MRI signal:
- type 1 Starts with degenerative changes causing inflammation and oedeme (T2 bright).
- type 2 Progresses to chronic inflammation with some fatty change, causing T1 bright.
- type 3 Finally, all gets burned out and fibrotic (T1 and T2 dark).
Type 1 changes look a lot like osteomyelitis

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9
Q

Annular tears (3)

A

Tears in the dorsal annulus, usually T2 bright and curvilinear.
May be a source of pain (radial pain fibers trigger “discogenic pain”), also seen as incidentals.

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10
Q

Myelogram technique (4)

A

Contrast should flow freely away from the needle tip, gradually filling the thecal sac.
Outlining of the cauda equina is another promising sign of correct position.
Contrast pooling at the needle tip or along the posterior or lateral thecal sac, without free-flow, suggests injection into subdural space or into the fat around the thecal sac.

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11
Q

Precautions prior to LP (5)

A

Aspirin and NSAIDs are fine.
Hold heparin for 2-4hrs.
Hold LMWH for 12hrs
Hold clopidogrel for 7 days.
Hold warfarin for 4-5 days

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12
Q

Complications of spine surgery (6)

A

Recurrent residual disc
- lacks enhancement (unlike a scar which has delayed enhancement)
Epidural fibrosis
- Scar that is usually posterior and enhances homogenously
Arachnoiditis
- “Clumped nerve roots” and “empty thecal sac”.
- Enhancement for 6 weeks post op is normal, after is infectious or inflammatory
Conjoined nerve roots
- 2 adjacent nerve roots sharing an enlarged common sleeve, at a point during their exit from the thecal sac

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13
Q

Failed back surgery syndrome (3)

A

Defined as recurrent or residual low back pain in the patient after disk surgery.
Occurs about 40% of cases.
Causes of FBSS are grouped into early and late.

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14
Q

Jefferson fracture (4)

A

Burst fracture of C1 caused by axial loading. Blow is typically to top of head.
Anterior and posterior archest blow out laterally.
Neurologic cord damage is rare, all the force is directed to bones

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15
Q

Odontoid fracture classification (3)

A

Type 1: Upper part of odontoid, may be stable, rare
Type 2: Fracture at the base, unstable, by far most common.
Type 3: Fracture through dens into the body of C2. Unstable, but best healing prognosis

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16
Q

Os odontoideum (5)

A

Mimic of type 1 fracture of odontoid.
Ossicle located at the position of the normal odontoid tip (orthotopic position).
Base of dens is usually hypoplastic.
Prone to subluxation and instability, associated with Morquio’s syndrome
Orthotopic vs Dystopic: Orthotopic is position right on top of the dens, Dystopic is when it’s fused to the clivus.

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17
Q

Hangman’s fracture (5)

A

Seen most commonly when chin hits dashboard (direct blow to the face).
Bilateral pars fracture at C2, or the pedicles which is less likely.
Anterior subluxation of the C2 body.
Cord damage is uncommon, as the acquired pars defect allows for widening of the canal.
Often associated fracture of the anterior inferior corner at C2, from avulsion of the anterior longitudinal ligament.

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18
Q

Flexion teardrop (3)

A

Teardrop shaped fragment at the anterior-inferior vertebral body.
Flexion injury is bad because it’s associated with anterior cord syndrome (85% have deficits).
Unstable fracture, associated with posterior sublixation of the vertebral body.

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19
Q

Anterior cord syndrome (3)

A

Anterior portion of the cord affected.
Motor function and anterior column sensations (pain and temperature) are compromised.
Dorsal column sensations (proprioception and vibration) are still intact

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20
Q

Extension teardrop (2)

A

Anterior inferior teardrop shaped fragment with avulsion of the anterior longitudinal ligament.
Less serious than the flexion type

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21
Q

Flexion vs Extension teardrop (4)

A

Impaction injury vs distraction injury
Unstable vs maybe stable
Hyperflexion vs Hyperextension
Ran into wall vs hit from behind

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22
Q

Clay-shoveler’s fracture (4)

A

Avulsion injury of a lower cervical/upper thoracic spinous process, usually C7.
Due to forceful hyperflexion movement like shovelling.
Ghost sign describes double spinous process at C6-C7

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23
Q

Facet dislocation (2)

A

Spectrum of subluxed facets –> perched –> locked.
Can be unilateral or bilateral

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24
Q

Unilateral facet dislocation (3)

A

Usually due to hyperflexion and rotation.
Superior facet slides over the inferior facet and gets locked.
Unilateral is a stable injury.
Inverted hamburger sign on axial imaging on the dislocated side

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25
Q

Bilateral facet dislocation (4)

A

Due to severe hyperflexion.
Disruption of the posterior ligament complex.
Dislocated vertebra can be displaced forward one-half AP diameter of the vertebral body.
Highly unstable and strongly associated with cord injury

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26
Q

Atlantoaxial instablity (5)

A

Articulation between C1 and C2 allows for lateral movement of the head.
Transverse cruciform ligament straps the dens to the anterior arch of C1.
Distance between anterior arch and dens shouldn’t be more than 5mm.
Instability associated with Downs and Juvenile RA.
Rotary subluxaiton can occur in children, looks like torticollis.
May require dynamic movements while scanning to differentiate from torticollis.

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27
Q

Benign vs malignant compression fracture (6)

A

Retropulsed fragment vs convex posterior vertebral body cortex
Transverse t1 and t2 dark band for benign.
Malignant:
- Involves posterior elements.
- Epidural/paraspinal mass
- Multiple lesions

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28
Q

Trauma to cord (2)

A

Known correlation between spinal cord oedema lenght and outcome.
Most important factor for outcome is the presence of haemorrhagic spinal cord injury.

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29
Q

Spinal cord syndromes (6)

A

Central cord:
- Old lady with spondylosis or young with bad extension injury
- Upper extremity deficit is worse than lower (corticospinal tracts are lateral in lower extremity)
Anterior cord
- Flexion injury, causes immediate paralysis
Brown sequard
- Rotation injury or penetrating trauma.
- One half motor, other half sensory
Posterior cord
- Uncommon, sometimes seen with hyperextension
- Proprioception affected

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30
Q

Pars interarticularis defects (6)

A

Fatigue or stress fracture, probably developing in childhood.
Usually not symptomatic (25% are).
Commonest level is L5-S1, with the rest at L4-5.
Tend to have more spondylolisthesis and associated degenerative change at L4-5 than L5-S1.
Can be seen on oblique plain film as a collar on the scottie dog.
Pars defects with anteriorlisthesis will have neuroforaminal stenosis, with spinal canal widening (when severe, will have spinal canal stenosis also).

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31
Q

Terminal ventricle (6)

A

aka ventricularis terminalis.
Developmental variant.
Normally, a large portion of the distal cord involutes in a late stage of spinal cord embryology.
Sometimes, this process is not uniform, and a cyst forms at the end of the cord.
This is usually small (4mm) and causes no symptoms.
Sometimes they get very big and cause neurilogic symptoms.

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32
Q

Spinal dysraphism (3)

A

Open or closed (closed with or without a mass).
Open means neural tissue is exposed through a defect in bone and skin (spina bifida aperta).
Closed means the defect is covered by skin (spina bifida occulta)

33
Q

Open spinal dysraphisms (6)

A

Result of failure of the closure of the primary neural tube, with obvius exposure of neural placode through a midline defect in the skin.
Dorsal defect in the posterior elements.
Cord is tethered.
Associated with diastematomyelia and Chiari II malformations.
Early surgery is Rx.
Myeloceles - rare type where neural placode is flush with skin.
Myelomeningoceles - common type, nerual placode protrudes above the skin. More common with Chiara II.

34
Q

Closed spinal dysraphisms with subcutaneous mass (6)

A

Meningoceles: Herniation of a CSF filled sac through a defect in the posterior elements (spina bifida).
Most common in the lumbar or sacral spine.
Can be anterior (pre-sacral).
Neural tissue is not present in the sac.
Lipomyelocele/Lipomyelomeningocele:
Lipomas with a dural defect.
Subcutaneous fatty mass above the gluteal crease.
All associated with tethered cord.
Terminal myelocystocele: Herniation of terminal syrinx into a posterior meningocele via a posterior spinal defect.

35
Q

Closed spinal dysraphisms without subcutaneous mass (9)

A

Intradural lipomas
- Most common in the thoracic spine,a lso the dorsal aspect.
- Don’t need to (but can) be associated with posterior element defects.
Fibrolipoma of the filum terminale
- Often incidental.
- Linear T1 bright structure in the filum terminale.
- Filum is not unusually thickened and conus is normally located
Tight filum terminale
- Thickend filum terminale (>2mm) with low lying conus (below inferior endplate of T2)
- Associated terminal lipoma may be present.
- “Tethered cord syndrome” is based on clinical findings of low back pain and leg pain plus urinary bladder dysfunction.
- Due to stretching of the cord with growth of the canal.
Dermal sinus
- Epithelium lined tract that extends from the skin to the deep soft tissues (sometimes spinal canal, sometimes dermoid or lipoma).
- T1 low signal relative to background fat.

36
Q

Diastematomyelia (4)

A

Sagittal split in the cord, usually between T9-S1, with normal cord above and below.
Can have 2 thecal sacs or 1.
Each hemicord has its own central canal and dorsal/ventral horns.
Classified based on presence or absecnce of osseous or fibrous spur and duplication or non duplication of the thecal sac.

37
Q

Caudal regression (4)

A

Spectrum of defect in the caudal region, ranges from partial agenesis of the coccyx to lumbosacral agenesis.
Association with VACTERL and Currarino triad and maternal diabetes.
“Blunted sharp” high terminating cord is classic, with a “shield sign” from opposed iliac bones (no sacrum).

38
Q

Currarino triad (3)

A

Anterior sacral meningocele
Anorectal malformation
Sacrococcygeal osseous defect (scimitar sacrum)

39
Q

Spinal AVFs/AVMs (8)

A

4 types:
Type 1: most common type (85%), dural AVF with single coiled vessel.
Due to fistula between dorsal radiculomedullary arteries and radiculomedullary vein/coronal sinus, with the dural nerve sleeve.
Acquired, seen in older patients with progressive myelopathy.
Most commonly thoracic spine
Type 2: Intramedullary nidus from anterior spinal artery or posterior spinal artery.
Can have aneurysms and can bleed.
Most common presentation is SAH.
Associated with HHT and KTS (other vascular syndromes).
Type 3: Juvenile, very rare, often complex, terrible prognosis
Type 4: Intradural perimedullary, with subtypes depending on single vs multiple arterial supply.
Tend to occur near the conus.

Gold standard for diagnosis is angiography, but CT or MRI will work.
T2 high signal in central cord, swollen cord, with serpentine perimedullary flow voids (usually dorsal)

40
Q

Foix Alajouanine syndrome (4)

A

Myelopathy associated with a dural AVF.
Classically 40s male with leg weakness and sensory deficits.
Increased T2 signal (conus or lower throacic spine), with associated prominent vessels.
Underlying pathology is venous hypertension, secondary to the vascular malformation.

41
Q

Pagets of the spine (4)

A

Incidence increases with age (8% at age 80).
Increased risk for fractures.
1% risk of sarcoma degeneration (usually high grade)
Seen as either enlarged “ivory vertebrae” or “Picture frame vertebrae”.

42
Q

Renal osteodystrophy (2)

A

“Rugger jersey spine” with sclerotic bands at the top and bottom of the vertebral body.
Can also have paraspinous soft tissue calcifications.

43
Q

Osteopertosis (4)

A

Genetic disease with impaired osteoclastic resorption.
Thick cortical bone, with deminished marrow.
Can look like Rugger Jersey spine or Sandwich vertebrae.
MR: loss of normal T1 bright marrow (marrow is T1 and T2 dark)

44
Q

H shaped vertebra (4)

A

Usually buzzword for sickle cell, although only seen in 10%.
Results from microvasculature endplate infarct.
Could also be due to Gauchers.
Widened disc spaces is another way to describe it.

45
Q

Discitis/osteomyelitis (6)

A

Infection of the disc and vertebral body usually go together.
Due to route of seeding typically involving seeding of the vertebral endplate (Vascular), subsequent eruption and crossing into the disc space, and eventual involvement of the adjacent vertebral body.
In adults, the source is usually recent surgery, procedure, or systemic infection.
In kids, usually due to haematogenous spread.
Staph A is commonest bug, and always consider IVDU.
ESR and CRP are usually elevated.
MRI: Paraspinal and epidural inflammation, t2 bright disc signal and disc enhancement.

46
Q

Pott’s disease (5)

A

TB of the spine, more common in developing countries.
Tends to spare the disc space.
Tends to have multiple level thoracic “skip” involvement.
“Calcified psoas abscess”
“Gibbus deformity” - destructive focal kyphosis

47
Q

Brucellosis (4)

A

Uncommon in West.
Favours lower lumbar and SI joints, can spare disc space like TB.
Vertebral destruction and paraspinal abscess are less common.
“cow’s milk” or “farm exposure”

48
Q

Epidural abscess (4)

A

Infected collection between the dura and periostium.
Usually MSRA and patient is usually HIV or bad diabetic.
MRI shows T1 darl, T2 bright with diffusion restriction and peripheral enhancement.

49
Q

Syrinx (5)

A

also known as a hole in the cord.
Central high signal dilatation in the middle f the cord, surrounded by normal cord = central cord dilation or benign central cord dilation.
Same thing but cord looks abnormal (also high signal or atrophic), the word “myelia” is used.
Most (90%) cord dilations (healthy and sick) are congenital, associated with Chiari I and II, as well as Dandy walker, Klippel Feil and Myelomeningoceles.
Other 10% are acquired by trauma, tumour or vascular insufficiency.

50
Q

Demyelinating lesions (7)

A

Almost always MS.
Other causes of demyelination are Neuromyelitis Optica (NMO), Acute disseminating encephalomyelitis (ADEM), Transverse myelitis (TM)
MS: Usually short segment, usually part of the cord. Not swollen. Can enhance/restrict when acute.
TM: Usually long segment, involving both sides of the cord. Expanded swollen cord. Can enhance.
NMO: Usually long segment, involves both sides of cord and optic nerves.
ADEM: Cord is not swollen.
Infarct: usually long segment, restricts diffusion
Tumour: Expanded swollen cord, can enhance.

51
Q

MS in spinal cord (6)

A

“multiple lesions over space and time”
Lesions in the spine are typically short segment, usually only affect half or part of the cord.
Cervical cord is the most common location.
Usually lesions in the brain, if there are lesions in the cord.
Lesions can enhance when acute, more common in the brain.
Can sometimes see cord atrophy is the disease burden is big.

52
Q

Transverse myelitis (6)

A

Focal inflammation of the cord.
Causes are many (infection, vaccination (rabies), SLE, Sjogrens, Paraneoplastic, AV malformations)
Typically at least 2/3 of the cross sectional area of the cord, and focal enlargement of the cord.
Acute partial involves less than 2 segments, acute complete involves more than 2 segments.
Acute partials are higher risk of developing MS.

53
Q

ADEM (5)

A

Usually seen after viral illness or infection, typically child or young adult.
Lesions favour the dorsal white matter (but can involve grey).
Presence of cranial nerve enhancement is suggestive of ADEM.
Associated with “anti-MOG IgG”.
Usually brain lesions too, can occur in the basal ganglia and pons which is unusual in MS.

54
Q

NMO (5)

A

Sometimes also called Devics.
Monophasic or relapsing, favours optic nerves and cervical cord.
Longer segment than MS and involve full transverse diameter of the cord.
Brain lesions can occur and usually periventricular (NMO IgG attacks aquaporin 4 channels which are found there).

55
Q

Subacute combined degeneration (4)

A

B12 deficiency.
Bilateral symmetrically increased T2 signal in the dorsal column, without enhancement.
Appearance has been described as an inverted V sign.
Signal change typically befins in the upper thoracic region with ascending or descending progression

56
Q

HIV vacuolar myelopathy (3)

A

Late finding in AIDS patients.
Spinal cord atrophy, and T2 high signal symmetrically involving the posterior columns.
Looks like subacute combined degeneration

57
Q

Spinal cord infarct (6)

A

Cord infarct/ischaemia can have a variety of causes, most commonly idiopathic.
Also common cause is treating an aneurysm with a stent graft or embolizing a bronchial artery.
Impairment involving the anterior spinal artery distribution is most common.
Anterior spinal artery involvement will cause central cord/anterior horn cell high signal on T2.
Owl eye appearance of anterior spinal cord infarct is buzzword.
Usually long segment, being more than 2 segments.
Diffusion using single shot fast spin echo or line scan can be used with high sensitivity (to compensate for artefacts from spinal fluid movement)

58
Q

Arachnoiditis (6)

A

General term for inflammation of the subarachnoid space.
Can be infectious, but can also be post surgical.
Occurs in 10-15% of cases after spinal surgery, and can be a source of persistent pain/failed back.
“Empty thecal sac sign” - nerve roots are adherent peripherally, giving the appearance of an empty sac.
“Central nerve root clumping” - can range in severity from a few nerves clumping together, to all of them fused into a single, central scarred band

59
Q

Guillain Barre syndrome (6)

A

Autoimmune, causes ascending flaccid paralysis.
Seen in campylobacter infection, but also after surgery or with lymphoma or SLE.
Enhancement of the nerve roots of the cauda equina.
Facial nerve is most common cranial nerve affected.
Anterior spinal roots enhance more than posterior ones

60
Q

Chronic inflammatory Demyelinating Polyneuropathy (3)

A

CIDP. Chronic counterpart to GBS.
Clinically: gradual and protracted weaknes (GBS improves in 8 weeks, this doesn’t)
Thickened, enhancing “onion bulb” nerve roots.

61
Q

Tumour DDx (9)

A

Intramedullary
- Astrocytoma, Ependymoma, Haemangioblastoma
Extramedullary intradural
- Schwannoma, Meningioma, Neurofibroma, Drop mets
Extradural
- Disc disease (most common), bone tumours, mets, lymphoma

62
Q

Astrocytoma (4)

A

Most common intramedullary tumour in paeds.
Favours upper thoracic spine.
Fusiform dilatation of the cord over multiple segments.
Dark on T1, bright on T2, enhance.
May be associated with rostral or caudal cysts, which are usually benign syrinx formation.

63
Q

Ependymoma (6)

A

Most common primary cord tumour of the lower spinal cord, conus/filum terminale.
Most commoin intramedulalry mass in adults.
Seen in cervical cord too.
“Myxopapillary form” is exclusively seen in the conus/filum.
Can be haemorrhagic, have a dark cap on T2.
They have tumoural cysts in 25%.
Typically long segment (averaging 4 segments)

64
Q

Astrocytoma vs ependymoma (5)

A

More in cervical cord vs more in lower cord.
Eccentric vs central
Longer segment bs shorter segment.
Less often haemorrhagic vs more often haemorrhagic.
Most common intramedullary in paeds vs adults

65
Q

Haemangioblastoma (4)

A

Associated with VHL.
Thoracic level is favoured, then cervical.
Wide cord with considerable oedema.
Adjacent serpinginous draining meningeal varicosities can be seen

66
Q

Intramedullary mets

A

Very rare, usually lung

67
Q

VHL associations (6)

A

Phaeochromocytoma,
CNS haemangioblastoma
Endolymphatic sac tumour
Pancreatic cysts
Pancreatic islet cell tumours
Clear cell RCC

68
Q

Schwannoma (5)

A

Commonest tumour to occur in the extramedullary intradural location.
benign, usually solitary, usually arising from the dorsal roots.
Can be multiple in NF2 and Carney complex.
Classically dumbbell with skinny handle beng intraforaminal component.
T1 dark, T2 bright and enhance.
Look like neurofibromas.
If they have central necrosis or haemorrhage, this favours neurofibroma

69
Q

Neurofibroma (5)

A

Another benign nerve tumour, also usually solitary.
Solitary or plexiform forms.
Plexiform is a multiple level bulky nerve enlargement, pathognomonic for NF1.
Lifetime risk for malignant transformation is around 5-10%. Suggested by rapid growth.
Look like schwannomas. Hyperintense T2 rim with central area of low signal “target sign” suggests neurofibroma.

70
Q

Schwannoma vs Neurofibroma (6)

A

Do NOT envelop adjacent nerve root vs Envelops adjacent nerve root (usually a dorsal sensory root)
Associated with NF2 vs NF1.
Cystic change/haemorrhage vs T2 bright rim, T2 dark center, target sign

71
Q

Meningioma (5)

A

Adhere to but don’t originate from the dura.
More common in women.
Favour the posterior lateral thoracic spine and anterior cervical spine.
Enhance brightly and homogenously.
Often T1 iso to hypo, slightly T2 bright, have calcifications

72
Q

Drop mets (3)

A

Medulloblastoma is most common primary.
Breast cancer is most common systemic tumour to drop, then lung and melanoma.
Cancer may coat the cord or nerve root, leading to fine layer of enhancement.

73
Q

Vertebral haemangioma (3)

A

Very common, seen in 10% of the population.
Classically have thickening trabecular appearing as parallel lineal densities “jail bar” or “corduroy” appearance.
T1 and T2 bright in vertebral body.
Extraosseous components are isointense on T1

74
Q

Osteoid osteoma (4)

A

Tend to involve posterior elements, rare after age 30.
Have a nidus, and surrounding sclerosis.
Nidus is T2 bright and will enhance.
Night pain, improved with aspirin.
RF ablation can treat under certain conditions

75
Q

Osteoblastoma (2)

A

Similar to osteoid osteoma, but >1.5cm.
Very often in posterior elements, usually cervical spine.

76
Q

Aneurysmal bone cyst (3)

A

Prefer posterior elements, usually seen before 20YO.
Expansile and can have multiple fluid levels on T2.
Can get big and look aggressive

77
Q

Giant cell tumour (3)

A

Common in sacrum and rare elsewhere in the spine.
Don’t see in young kids.
Lytic expansile lesion in the sacrumw ith no rim of sclerosis

78
Q

Vertebral plana (2)

A

Pancake flat vertebral body.
Due to Eosinophilic granuloma in kid and mets/myeloma in adult.

79
Q

Chordoma (4)

A

Most common in sacrum.
Vertebral primary tend to be more agressive/malignant than the clivus or sacral counterparts.
Classic story in vertebral column is “involvement of 2 or more adjacent vertebral bodies with the intervening disc”
Most are very T2 bright

80
Q

Leukaemia (2)

A

Loss of normal fatty marrow, homogenously dark on T1.

81
Q

Mets (4)

A

Classically prostate, breast, lung, lymphoma, melanoma.
Multiple lesions with low T1 signal.
Cortical breakthrough or adjacent paravertebral components are helpful.

FRCR 2A (Crack The FRCR 2A) (61 decks)

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