Spine Flashcards
(86 cards)
Brief description of anatomy of intervertebral discs
What occurs to the disk that results in IVDD?
Myelography vs CT in evaluation of acute thoracolumbar IVDD in chondrodystrophic dogs. VRU 50.4 (2009)
Anatomy: Jelly donut center (nucleus pulposus), vs firmer rim, annulus fibrosis
Type 1: nucleus pulposus undergoes chondroid degeneration and minneralization, annulus fibrosus weakens, and disk material extrudes
Type 2: annulus fibrosis progressively thickens due to fibroid degeneration - progressive protrusion of the disc.
Complications of myelography?
Myelography vs CT in evaluation of acute thoracolumbar IVDD in chondrodystrophic dogs. VRU 50.4 (2009)
Radiation exposure (techs/radiologists/patient), adverse reaction to contrast, asystole, intracranial subarachnoid hemorrhage, seizures
In the article: Myelography vs CT in evaluation of acute thoracolumbar IVDD in chondrodystrophic dogs. VRU 50.4 (2009),
2 CT protocols, plain films, and meylography were compared (conventional vs helical).
What was benefits/sensitivity of each modality for site location and lateralization?
Conventional: Site: 87.4% sensitivity. Lateralization: 87.4%
Helical: Site: 88.4% sensitivity. Lateralization: 85%
Myelography: Site: 98% sensitivity. Lateralization 79%
Plain films: Site: 94% sensitivity
In the article: Myelography vs CT in evaluation of acute thoracolumbar IVDD in chondrodystrophic dogs. VRU 50.4 (2009),
2 CT protocols and meylography were compared (conventional vs helical).
What were the drawbacks of each modality?
Myelography: time, risks (seizures, hemorrhage, asystole, contrast reaction), concurrent hemorrhage/swelling, filling of epidural space can make it difficult to interpret.
CT: Thin slices –> decreased SNR. Thicker slices –> decreased quality due to volume averaging.
Evaluation of different CT techniques and myelography for diagnosis of acute canine myelopathy. VRU 51.3 (2010).
Compared conventional CT, CT angiography, CT myelography and standard myelography.
What is ranking of most sensitive to least sensitive?
What about when mineralized discs were excluded?
CT myelograph (97%) > Myelography (79%) > Conventional CT (66%) > Angiographic CT (53%).
When Mineralized discs were excluded - sensitivity of conventional and angiographic CT decreased by approximately 20%.
Evaluation of different CT techniques and myelography for diagnosis of acute canine myelopathy. VRU 51.3 (2010).
Which imaging modality used in this study was reliant on mineralization or lytic lesions?
Conventional CT and CT angiography
Evaluation of different CT techniques and myelography for diagnosis of acute canine myelopathy. VRU 51.3 (2010).
What was agreement between imaging modalities (myelography, CT myelography, CT angiography, Conventional CT), and in which examples were agreement improved?
Agreement was low for survery and angiographic CT (0.2 and 0.23, respectively) vs myelography and CT myelography (0.74 and 0.88).
Agreement was much higher when evaluating for large volume disc extrusion
Evaluation of different CT techniques and myelography for diagnosis of acute canine myelopathy. VRU 51.3 (2010).
In this article, agreement was high for myelography and CT myelography, and low for conventional CT and angiography (except for when evaluating large mineralized disc extrusions).
Where did myelography struggle?
When spinal cord swelling was present. Spinal cord swelling was detected, but it was more difficult to evaluate where the extradural site or lateralization – was better on CT myelography.
Was the vacuum phenomenom helpful in determining site of the lesion in the article:
Evaluation of different CT techniques and myelography for diagnosis of acute canine myelopathy. VRU 51.3 (2010).
No. 3/5 dogs were incorrectly localized based on vacuum phenomenon alone.
What was overall conclusion of the study: Evaluation of different CT techniques and myelography for diagnosis of acute canine myelopathy. VRU 51.3 (2010).
Meaning - what imaging modality is recommended in each case?
chondrodystrophic breeds paraparetic- Conventional CT is usually adequate.
Chondrodystrophic dogs that are plegic, spinal cord swelling, low volume cervical disc extrusion, non-chondrodystrophic breeds - may require CT myelography
What MRI findings would you expect to see in an acute non-compressive nucleus pulposus extrusion?
De Risio, Luisa “association of clinical and MRI findings with outcome ind ogs with presumptive ANNPE: 42 cases” JAVMA 234.4
- Focal hyperintensity within spinal cord overlying an intervertebral disc
- Reduction in volume and signal of intervertebral disc on T2
- Narrowed intervertebral disc space
- Extraneous material or signal change within epidural space dorsal to affected disk
- Minimal
According toDe Risio, Luisa “association of clinical and MRI findings with outcome ind ogs with presumptive ANNPE: 42 cases” JAVMA 234.4, what MRI findings are correlated with an unsuccessful outcome?
Severity of neurologic signs
GRE hypointensity (hemorrhage within spinal cord)
PCSAL (cross-sectional area of lesion) - >90% had 92% chance of having unsuccessul outcome.
In a 2009 Hecht paper, how did myelography,helical CT and conventional CT compare with regards to accuracy in detecting level and localization of extruded disc material in chondrodystrophic dogs?
They were similar and had a high degree of accuracy for level (myelography 94.7%, conventional 100%, helical 94.7%). Myelography was lessfor level and localization though conventional and helical CT were similar(myelography 78.9%, conventional 87.4%, helical 85.3%).
2009 Hecht - Myelography vs. computed tomography in the evaluation of acute thoracolumbar intervertebral disk extrusion in chondrodystrophic dogs
What is the difference between Hansen Type I and II in terms of pathology?
Type I -nucleus pulposus undergoes chondroid degeneration and subsequent mineralization -> annulus fibrosus weakens and disk material can extrude into verterbral canal causing acute neuropathy = chondrodystrophic
Type II -annulus fibrosus undergoes progressive thickening due to fibroid degeneration which can result in progressive protrusion of the affected disk into the verterbral canal = large breed
What are some adverse reactions of myelography?
Seizures, asystole, intracranial subarachnoid hemorrhage
2009 Hecht - Myelography vs. computed tomography in the evaluation of acute thoracolumbar intervertebral disk extrusion in chondrodystrophic dogs
What can cause hemorrhage within the spinal cord?
Susceptibility artifacts on T2*w MRI of the canine and feline spine. VRU 56.4 (2015)
intervertebral disc extrusion, coagulopathy, trauma, iatrogenic trauma, hemorrhagic myelomalacia, neoplasia, parasitism, vascular malformations
What are differentials for T2 hyperintensity within the spine?
Susceptibility artifacts on T2*w MRI of the canine and feline spine. VRU 56.4 (2015)
Necrosis, myelomalacia, intramedullary hemorrhage, inflammation, edema, neoplasia.
What is common clinical complaint of patients presenting for ischemic myelopathy?
acute, asymmetric spinal cord disease that is non-painful and non-progressive after the initial 24h.
Degree of recovery depends on the severity of initial injury to the spinal cord.
In the article MRI findings of suspected ischemic myelopathy (VRU 46.3 (2005)) - what were MR findings consistent with this diagnosis?
T2 images: hyperintense
T1: pre contrast: varied based on the age - early (3m)
Post contrast: mild enhancement in
In humans, what are MR findings of ischemic myelopathy?
MRI findings of dog swith suspected ischemic myelopathy. VRU 46.3. (2005)
T2 hyperintensity (93%)
T1: hypointense (70%)
Contrast enhancement: 40% - usually occuring in middle aged lesions (5-6d), absent enhancement by 1m after accident.
Give a brief description of the blood supply to the spinal cord
MRI findings of suspected ischemic myelopathy. VRU 46.3. (2005).
Ventral spinal artery with central branch that extends through ventral fissure than branches to supply intermediate and ventral gray matter of spinal cord and surrounding white matter
Two paired, dorsolateral spinal arteries that suply dorsal gray and dorsolateral white matter
What are MRI findings of acute ischemic myelopathy?
MRI findings and clinical associations in 52 dogs with suspected ischemic myelopathy. JVIM 21. (2007).
Focal, relative sharply demarcated intramedullary lesions, involving predominantly gray matter that is hyperintense on T2w images and iso or hypointense on T1 images.
Various degrees of contrast enhancement depending on time between onset of clinical signs and MRI
The severity of clinical signs (most notably the ambulatory status) correlated with what imaging findings in the articleMRI findings and clinical associations in 52 dogs with suspected ischemic myelopathy. JVIM 21. (2007).
Length of hyperintense lesion on T2 sagittal images when compared to L2 or C6.
Maximal cross sectional area of hyperintense lesion on T2 images
AKA the longer and thicker the lesion - the more severe the clinical signs.
What can cause susceptibility artifacts on T2* weighted images?
Susceptibility artifacts on T2*w MRI of the canine and feline spine. VRU 56.4 (2015)
paramagnetic blood degradation products (hemorrhage), mineralization or metallic particles