Spinal Radiology Flashcards
Imaging the Spine (Pathology& techniques)
• Degenerative Disease
• Inflammatory Disease
• Osteoporosis
• Neoplastic Disease
Plain Films
• Nuclear Medicine
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Bone Densitometry
Plain films
Readily available
Structural information
• Vertebral collapse
• Spondylolisthesis
• Scoliosis Insensitive to early disease
Bone Densitimetry (DEXA)
Dual energy X-rays
Differential Absorption
Comparison with a population dataset
Dependent on bone density Structural information No information about other disease processes
Nuclear Medicine - “Bone Scan”
“Functional” Scan
Sensitive not specific
Radiation
Imaging the Spine CT
CT
– a microscope
– widely available
– access for
patients unable to have MRI
– radiation
– may be falsely
reassuring
Imaging for Back pain
Majority with LBP respond to conservative Tx and require no imaging
• Imaging required when LBP is persistent to exclude sinister pathology
– Malignancy, infection, vertebral collapse
Historically plain films first investigation (> 6/52 persistent low back pain)
MRI
Main spinal imaging
But
Expensive and time consuming
Imaging Back Pain
Limitations of plain films
• Insensitive to early stages of disease
• Visualization of destructive lesion requires loss of>80% Of medullary Bone
• Vertebral Compression fractures
– Unable to distinguish acute from chronic
Unable to distinguish being from malignant
Imaging Low Back Pain
Limitations of plain films
• May miss acute pars fractures particularly in the pre-fracture state
Radiation dose
Typical effective dose of lumbar spine x-ray (mSv) = 1.3 mSv
– Equivalent to 65 chest x-rays
– or 7 month period of natural background radiation exposure
Imaging LBP with MRI
Limitations of the study – Unable to make a direct comparison with PF
• Indirect comparison with previous studies suggests MRI detects 2x the number of patients with significant disease.
It is clear that some lesions detected would not have been visualized with PF
– Acute pars stress oedema
– Early spondylo-arthropathy
or disc infection
- Neurogenic tumors
More info on vertebral #
Strait to MRI on young people
Multidisciplinary Team Meeting
• Discussion of complex or contentious cases
• Planning further management
• Education of clinicians (and trainees)
DoH 18 week target
• Presentation
• History
• Examination
• Special Investigations
• Diagnosis
• Treatment
• Special Investigations
Innovation and Technology
• Voice recognition technology
– No need for transcriptionist
– Immediate report validation
– Desktop-Desktop image and report transmission
• Voice-over ip web technology
-Skype
– Remote global communication with Clinicians/GPs
The role of radiology in therapeutic management
Vertebroplasty
• Radio-frequency ablation
• Peri-neural injections
• Facet joint injections
Vertebroplasty
Involves injecting polymethylmethacrylate (PMMA) cement into a collapsed vertebral body
