Imaging the Spine Flashcards
myelogram
injecting contrast into the subarachnoid space to localize lesions as:
- extradural
- intradural/extramedullary
- intramedullary/intrinsic
extradural lesions
located between the dura and the bone
- displaces BOTH meninges and parenchyma
intradural/extramedullary lesions
located within the subarachnoid space
- displaces ONLY parenchyma
intramedullary (intrinsic)
located within the brain parenchyma
- forms a bulge within the parenchyma
categories of spinal cord disease
- developmental
- trauma
- degenerative
- vascular
- inflammatory
- neoplastic
common developmental spinal cord diseases
- spina bifida
- vertebral anomalies
- hypoplastic odontoid process
- cervical spondylomyelopathy
- chiari-like malformation
spina bifida
failure of dorsal vertebral ossification center fusion
vertebral anomalies
fusion failure/developmental dysfunction of vertebrae
- causes scoliosis, lordosis, kyphosis
hypoplastic odontoid process
fusion of C2 and C3 that causes instability in occipito-atlanto-axial joint
underdeveloped dens causes increased space between C1 and C2
- leads to spinal cord compression
cervical spondylomyelopathy
Wobblers syndrome; cervical vertebral malformation
- causes spinal instability, canal stenosis, articular facet/ligament/joint capsule remodeling
- leads to IVD protrusion
chiari-like malformation
occipital malformation affecting the foramen magnum and caudal fossa
decreased size of occipital bone causes increased size of foramen magnum
- leads to cerebellar herniation through foramen magnum –> secondary syringomyelia
imaging: syrinx
syrinx
fluid filled dilation of the central canal along the spinal cord caused by backup of CSF
common spinal cord trauma
spinal fracture
radiographs: shortened vertebral body with compression of spinal cord
CT: fragments visible
common degenerative spinal cord diseases
disc herniations –> spinal cord compression
radiographs: spinal cord compression visible with myelogram; narrowed disc space with mineralized material
CT: dark disc (should be well hydrated = bright)
common vascular spinal cord diseases
infarctive disorders (fibrocartilagenous embolism)
asymmetric intrinsic lesions
T2 hyperintense bulge
non-contrast enhancing (necrotic tissue)
fibrocartilagenous embolism
sudden blockage of spinal cord blood supply with disc material
acute onset, non-progressive
focal and well contained
common inflammatory spinal cord diseases
discospondylitis (infection of IVDs and adjacent vertebral endplates)
radiographs: lysis of vertebral endplates, narrow disc space
CT: T2 bright disc space, T1 + C contrast enhancing vertebral bodies and surrounding tissues
common neoplastic spinal cord diseases
plasma cell tumor
nerve sheath tumor
histiocytic sarcoma
plasma cell tumor
extradural tumor arising from bone
CT: mass + mass effect of flattening spinal cord
nerve sheath tumor
extramedullary/intradural mass in SAS
arises from nerve roots exiting the spinal cord
CT: T1 + C golf tee sign (contrast enhancement surrounding mass)
histiocytic sarcoma
intramedullary mass
CT: contract enhancing bulge within spinal cord