Spine imaging

Question 1

Why is fat suppressed sequence so helpful for MRI bone imaging in adults?

Answer 1

Because as you get older, your marrow becomes more fatty!

Question 2

Ddx of mechanical low back pain

Answer 2

Question 3

Imaging signs of ankylosing spondylitis

Answer 3

Question 4

Schuherman’s

Answer 4

Lots of Schmorel’s nodes in young people

Question 5

Paget’s disease

Answer 5

Question 6

CT vs MRI for bone imaging

Answer 6

Question 7

What group of patients with LBP need immediate imaging?

Answer 7

• Trauma cases
• Nontraumatic, acute onset (< 4-6 weeks) with red flags
• Cancer history (but talk to oncology first)
• Neurologic signs or cauda equina syndrome
• High risk of cancer
• People with high clinical suspicion of spinal infection (MRI)

Question 8

For suspected bone fracture, __ are usually appropriate

Answer 8

X-ray and CT

CT is more sensitive, especially for small fractures

MRI as a secondary study if the above are unrevealing.

Question 9

If you are thinking tumor or infection as an etiology of back pain, you should do. . .

Answer 9

. . . MR lumbar spine with and without contrast

Question 10

How can you tell if post-surgical lumbar back pain is due to granulation tissue or a new disc problem?

Answer 10

If you are in the right time frame, it could be either

MR w/ and w/o contrast will help you differentiate, as the granulation tissue is highly vascular and will enhance

Question 11

When evaluating neuronal tissue in suspected cauda equina or other neurologic deficit-associated back pain, what is the best imaging modality?

Answer 11

MRI without contrast

You don’ really need contrast unless you are looking for enhancement, and you aren’t necessarily.