Non-neoplastic spinal disease Flashcards
Imaging features of Modic changes
Type 1: Edema - hypo T1, hyper T2
Type 2: Fatty signal - hyper T1/T2 due to fatty proliferation from chronic inflammation
Type 3: Sclerotic - hypo T2, hypo T2
Type 1 more likely to be at level of acute pain
Most common location and organisms causing pyogenic osteomyelitis
lumbar > thoracic > cervical
Staph aureus most common (think gram neg E.coli, salmonella in sickle cell)
Imaging findings in pyogenic osteomyelitis
Endplate edema, enhancing disc space and vertebral bodies, paraspinal and/or epidural involvement in 75%
Need to correlate with serum markers/CRP in early cases because these can look like Modic 1 changes of DDD
Imaging findings in TB osteomyelitis (aka Pott’s disease)
Spares disc, sub-ligamentous spread (can jump levels), paraspinal abscesses common + calcification, late stage Gibbus deformity (most commonly in thoracic and thoracolumbar spine)
Imaging findings in sarcoidosis in the spine
Leptomeningeal enhancement with diffuse, peripheral mass-like enhancing lesions (often along dorsal surface)
long ddx: tumour, lymphoma, transverse myelitis - can correlate with ACE levels
Imaging findings of ADEM in the spine
Usually after viral illness/vaccination
Enlargement of cord, T2 hyperintense areas with variable enhancement and diffusion restriction
(WM lesions in brain)
DDx: Gibbus deformity (acute angle kyphosis)
Vertebral compression fracture (trauma, infection - TB) Congenital syndroms (achondroplasia - Hunter syndrome, mucopolysaccharidoses - Hurler syndrome)
Imaging findings spinal cord infarct
RFs?
Most common in upper thoracic or thoracolumbar spine
(lower cord supplied by artery of Adamkiewicz)
Symmetric hyperintense foci in grey matter of ventral horns - owl eye appearance
RFs: aortic surgery, arteritis, sick cell anemia, vascular malformation, disc herniation
Causes of tethered cord
Thickened filum Lipoma (in cord or filum) Adhesions from prior repair of myelomeningocele Split cord malformation Dermal sinus tracts Dermoid/epidermoid tumours
What is diastematomyelia? Diplomyelia?
Diastematomyelia - split cord
2 cords, 2 dural sacs, divided by bony spur
Commonly associated with vertebral abnormalities (spina bifida, hemivetebra, scoliosis); midline skin findings
Diplomyelia - duplicated cord
split cord malformation encompasses both of these terms
DDx for non-neoplastic intramedullary lesions in the spine and distinguishing features
- MS (typically dorsal and lateral, wedge shaped or punctate lesions)
- NMO (more often involving most of cord - TM, involving >3 levels, can have intracranial lesions but these are usually just around the ventricles only)
- Other causes of transverse myelitis: sarcoid, vasculitis, SLE, sjrogren’s
- ADEM (diffuse involvement of the cord -TM, no enhancement, WML in pons, BG, thalami)
- Infarct (owl’s eye)
What are the open spinal dysraphisms?
Exposure of abnormal nerve tissue through skin
- Myelomeningocele - expansion of CSF space + cord
- Myelocele - no expansion of CSF space, neural placode directly under skin
- *MYELO = contains neural elements
What are the closed spinal dysraphisms?
Covered by skin, no exposure of nerve tissue
A/w with mass:
- Lipomyelomeningocele
- Lipmyelocele
- Meningocele
- Myelocystocele (low lying conus with dilated central canal protruding outward)
No mass:
- Filar/intradural lipoma, persistent terminal ventricle, dermal sinus, diastomatomyelia, caudal agenesis
Most common spinal vascular malformation? Imaging appearance?
- Dural AVF
- Connection b/w radiculomedullary artery and vein in the dura of nerve root sleeve
- Diffuse multilevel intramedullary hyperintensity (edema), usually conus is involved
- Serpiginous intradural extra-medullary flow voids
4 types of spinal AVFs/AVMs
- Type 1: most common, dural AVF
- Type 2: Intramedullary nidus, +/-aneurysms, present with SAH
- Type 3: juvenile
- Type 4: intradural perimedullary, often near conus, variable number of supplying arteries
