Radiologic C/S eval Flashcards
List the ABCDs for viewing imaging
- Alignment
- Bone Signal
- Canal Space (also CNS for MRI)
- narrowing/indent (encroachment) in canal from potential structures
- Discs Integrity
- Soft tissues
List general indications for CT of the C-Spine
- Acute trauma (adults)
- Degenerative conditions
- Post-op assessment
- Infection
- Image-guided intervention procedures
- Neoplasm
- Inflammatory lesions
- Congenital/developmental conditions
- Cord syrinxes/masses (with MRI contraindicated)
what may be best observed with an axial CT of the C-spine?
- spatial relations → dens and lateral masses, dens and anterior arch
- atlantodental interface
- spinal canal
what may be best observed with a coronal CT of the C-spine?
- integrity of the dens
- spatial relations of C1 and C2
- a burst fracture or Jefferson’s fracture is best seen in this plane
list general indications for MRI of the C-spine
- Acute trauma with suspected cord encroachment
- DDD
- Neoplasm
- Dx and intervention f/u
- Intrinsic spinal cord pathology
- Congenital/developmental conditions
- Cord masses
- Post-op assessment (soft tissues, vertebroplasty)
- Meningeal abnormalities
- Infection
- disc space infections
- epidural abscess
what is myelomalacia? What is the best imaging to see it?
encroachment on the cord from a bulging disc resulting in softening of the spinal cord
best seen with a T2 MRI
what does PECARN stand for?
Pediatric Emergency Care Applied Research Network
what is PECARN?
a guideline that states → high risk for cervical spine injury (do imaging) if one or more of the following are present:
- AMS
- focal neurologic findings
- Torticollis (new onset)
- Substantial torso injury
- Conditions predisposing to cervical spine injury
- diving
- high-risk motor vehicle crash
list the 4 ACR Appropriateness criteria for the neck
- Cervical neck pain or cervical radiculopathy
- Myelopathy
- Suspected spine trauma
- Suspected spine trauma - child
what initial imaging is most appropriate for new or increasing nontraumatic cervical or neck pain with no red flags?
Radiography cervical spine
(MRI and CT may be appropriate but radiography is best)
what initial imaging is most appropriate for new or increasing nontraumatic cervical radiculopathy with no red flags?
MRI cervical spine
(CT and radiography may be appropriate also but not best choice)
what initial imaging is most appropriate for a patient with prior cervical spine injury who has new or increasing nontraumatic cervical/neck pain or radiculopathy?
Radiography or CT-scan of cervical spine
(MRI or CT myelography cervical spine may also be appropriate but not best choice)
what initial imaging is most appropriate when there is suspicion for infection with new or increasing nontraumatic cervical/neck pain or radiculopathy?
MRI cervical spine
(CT or radiography also good but not best choice)
what initial imaging is best for a pt with a known malignancy who presents with new or increasing nontraumatic cervical/neck pain or radiculopathy?
MRI cervical spine
(CT, radiography or bone scan also good but not best choice for initial)
what initial imaging is most appropriate for a pt with cervicogenic HA and new or increasing nontraumatic cervical/neck pain with no neurologic deficits?
no imaging technique is considered better than others here
MRI, Radiography, CT, facet injection/medial branch block of cervical spine may all be appropriate
what initial imaging is most appropriate for a pt with chronic neck/cervical pain?
Radiography cervical spine
(MRI may be appropriate but not best choice initially)
following a radiograph that show degenerative changes, what next imaging study is most appropriate for a patient with chronic neck/cervical pain with no neurologic findings?
MRI cervical spine
(CT cervical spine or CT myelography may also be appropriate but not next best choice)
following a radiograph that show ossification in posterior longitudinal ligament, what is the appropriate next imaging study for a patient with chronic neck/cervical pain with/without radiculopathy?
CT cervical spine
(CT myelography or an MRI may also be appropriate but not best choice)
what initial imaging study is most appropriate for an myelopathy (acute onset, chronic or progressive)?
MRI spine area of interest
(CT myelography or CT spine area of interest may also be appropriate but not best initial choice)
what initial imaging study is most appropriate for a child (ages 3-16) with acute cervical spine trauma that meet low risk criteria (based on PECARN or NEXUS)?
no imaging required
what initial imaging study is most appropriate for a child (age 3-16) with acute cervical spine trauma with at least 1 risk factor with reliable clinical examination (based on PECARN or NEXUS)?
Radiography cervical spine
(CT or MRI may also be appropriate but not best initial choice)
in general if a child (ages 3-16) has suspected spine trauma and meets criteria (PECARN, NEXUS, Pieretti-Vanmarcke) what is the most appropriate intial study?
radiography of spine area
T/F: if imaging is not indicated by NEXUS or CCR for pts ages 16-65 then they don’t need imaging?
TRUE
what initial imaging is most appropriate for a pt (age >16) with suspected acute cervical spine blunt trauma (imaging indicated by NEXUS or CCR)?
CT cervical spine
(Radiography cervical spine may also be appropriate but not best initial choice)
for a patient greater/equal to 16 years old, with suspected acute cervical spine blunt trauma, what is the best next imaging study when there is confirmed or suspected cervical spinal cord/nerve root injury?
(CT cervical already performed)
MRI cervical spine
(CT myelography may also be appropriate but not as good a choice as MRI)
for a patient older than 16 with an acute cervical spine injury detected on radiographs. What imaging study would be most appropriate to assist with treatment planning for their mechanically unstable spine?
CT cervical spine and MRI cervical spine
for a patient (older than 16) with a suspected acute cervical spine blunt trauma, what next imaging study would be most appropriate if their initial imaging/clinical findings suggest an arterial injury?
CTA head and neck or MRA usually appropriate
(arteriography cervicocerebral, or MRA neck may also be appropriate)
following a cervical CT, what next imaging study should be performed in an obtunded patient (older than 16) with no traumatic injury identified on CT but there is suspected acute cervical spine blunt trauma?
MRI cervical spine
if clinical or imaging findings suggest a ligamentous injury in the neck/cervical region what imaging study is best?
initially - CT
next study - MRI
