Imaging of spine Flashcards

1
Q

When should imaging be employed when patients present with back pain?

A

Most back pain patients don’t require imaging

Need to select patients that have potential for serious instability or neurological damage

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2
Q

When is plain film useful for spinal imaging?

A

Alignment

Fractures

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3
Q

When is MRI useful for spinal imaging?

A

Looking at soft tissue structures

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4
Q

When is CT useful for spinal imaging?

A

Fractures

Discs

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5
Q

Describe the curvatures of the spine?

A

Cervical and lumbar: lordosis

Thoracic and sacral: kyphosis

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6
Q

Describe the orientation of the facets in the lumbar spine?

A

Oblique

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7
Q

Describe the shape of vertebral bodies in the lumbar spine?

A

Concavity in lateral, anterior and posterior margins

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8
Q

Describe what is seen when viewing an X-ray of the anterior lumbar spine?

A

Thicker cortical bone

Concavity of body

Ring of shadows of cortex of pedicle

Spinal canal between pedicles

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9
Q

Describe why two lines of cortical bine are sometimes seen in imaging of the spine?

A

When cortical margin in oblique to X-ray beam

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10
Q

Describe what can be seen in an X-ray image of the lateral spine?

A

Thick and broad spinous process

Thicker cortical bone

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11
Q

Describe what can be seen in an oblique X-ray of the spine?

A

Scotty dog appearance

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12
Q

Where is a common fracture site of the spine in young people?

How does it appear on imaging?

A

Lamina - stress fractures

Neck of Scotty dog

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13
Q

Label the features of these X-rays?

A
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14
Q

How can intervertebral discs be visualised?

A

CT (T2 weighted)

MRI

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15
Q

Describe the appearance of the intervertebral discs in a T2 weighted C2 image?

A

Centre of discs appeasr bright

Strong signal due to water content of nucleus

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16
Q

Describe the arrangement of structures exiting the IV foramen?

A

Nerves superiorly

Small artery

Small nerve

Veins inferiorly

Surrounded by epidural fat

17
Q

Describe the way in which spinal nerves exit the spinal cord?

A

Cervical: nerve goes out above pedicle of same name

C8 below C7 and above T1

Rest beneath pedicle

18
Q

Which level has this axial image been taken at?

A

Below L1/L2 (cauda equina visible)

19
Q

Which spinal nerve is affected due to lateral protusion of L4/5 disc? Why?

Which spinal nerve is affected due to lateral protusion of L5/S1 disc? Why?

A

L4/5: Affects L5 spinal nerve, as L4 nerve root has already exited above

L5/S1: affects S1 spinal nerve, as L5 nerve root has already exited above

20
Q

Between which structures does the ligamentum flavum run?

A

Between laminae

21
Q

Locate the ALL, PLL and ligamentum flavum in the following images?

A
22
Q

Which ligaments are visible in axial spinal images?

A

Don’t see ALL and PLL well

Can see ligamentum flavum

23
Q

Why is MRI used for spinal imaging?

A

Discs

Spinal cord

Contents of canal

Nerve roots

24
Q

How are the spinous processes of the thoracic spine different to that of the lumbar spine?

A

Longer and more inferior direction

25
Q

Why is imaging of the thoracic spine more difficult than the lumbar spine?

A

Don’t see detail as well due to overlying structures

26
Q

What is visible in imaging of the thoracic spine?

A

Outline of vertebral bodies

Run down through pedicles

Spinous processes

27
Q

What is wrong with this image?

A

Increased kyphosis (due to softening of end plates)

28
Q

Describe this image?

A

Osteophytes in the elderly spine

29
Q

Describe what is wrong with this image?

A

Disc protrusion

30
Q

Can disc protrusions be visualised with CT?

A

Yes

31
Q

Identify the labelled structures in this image?

A

Spinal nerves exiting

32
Q

Describe the abnormality in this image?

A

Alignment abnormality

Spondylolisthesis

L4 slipped forward on L5

33
Q

What is bone scintigraphy?

What is it used for?

A

Injected technetium emits gamma rays > counted by scanner

Technetium taken up by osteoblasts

Assesses vascularity and osteoblastic activity (increased at fracture sites)

34
Q
A