Transcript SPINE & EXTREMITY IMAGING

SPINE
IMAGING
OD
LM
TP
B
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SP
AAC1
AAC2
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TP
TF
AP
SP
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AA
TF
PA
B
P
CVJ
R
L
SP
CTJ
PM
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SP
ZJ
SP
IVS
B
MPR
SIJ
F
Pathologies
Ankylosing spondylitis is a
type of arthritis that affects
the spine. Spondylitis may
cause pain and stiffness
from the neck down to the
lower back. The bones of
the spine, called vertebrae,
may grow or fuse together,
resulting in a rigid spine.
These changes may be
mild or severe, and may
lead to a stooped-over
posture.
Spondylolisthesis
Description
The most common X-ray identified cause of low
back pain in adolescent athletes is a stress fracture
in one of the bones (vertebrae) that make up the
spinal column. Technically, this condition is called
spondylolysis (spon-dee-low-lye-sis). It usually
affects the fifth lumbar vertebra in the lower back,
and much less commonly, the fourth lumbar
vertebra.
If the stress fracture weakens the bone so much that
it is unable to maintain its proper position, the
vertebra can start to shift out of place. This
condition is called spondylolisthesis (spon-dee-lowlis-thee-sis). If too much slippage occurs, the bones
may begin to press on nerves and surgery may be
necessary to correct the condition
HNP-herniated nucleus pulposus
Many types of tumors start in the
central nervous system (CNS)
(brain and spinal cord). If you
have one of these tumors, your
symptoms, outlook for survival
(prognosis), and treatment
depend on your age, the tumor
type, and the precise location of
the tumor within the CNS
Astrocytoma: Most tumors that
arise within the brain itself start
in brain cells called astrocytes.
These tumors are called
astrocytomas. About 35% of
brain tumors are astrocytomas.
Most astrocytomas cannot be
cured because they spread
widely throughout the
surrounding normal brain tissue.
Sometimes astrocytomas spread
along the cerebrospinal fluid
pathways. With only rare
exceptions, astrocytomas,
however, do not spread outside
of the brain or spinal cord
Astrocytoma
Definition
Lumbar Spinal Stenosis is derived from the
word stenosis meaning narrowing. Imagine
the spinal canal is a circle. The circle can be
average, big or small. Since the spinal nerves
travel in the circle at this level of the spine,
any narrowing of the circle could put pressure
on the spinal nerves. Unless the individual is
born with a small spinal canal (congenital
stenosis), spinal narrowing occurs most
commonly from progressive degenerative
changes (acquired spinal stenosis).
Spine stenosis
Fractures- Jefferson’s
A Jefferson fracture consists of a fracture of the C1 ring. This results
from an axial loading injury to the head with compression force to C1
(typically from diving).
Hangman’s fracture- C2-C3
Unstable hangman's type fracture of the C2 body and posterior
elements extending into the left foramen transversarium.
COMPRESSION FRACTURE
BURST FRACTURE
Burst fractures are comminuted fractures of the vertebral
bodies often associated with bone fragments in the canal
VACUUM “GAS”
PHENOMENON
Vacuum" phenomena relate to the accumulation of gas, principally
nitrogen, in crevices within the intervertebral disk or vertebra.
Protocols
C-SPINE
SCOUT: LAT
LANDMARK: XIPHOID
SLICE PLANE: OML
I.V. CONTRAST: FOR EVALUATION OF DEGENERATIVE DISK DISEASE,
DIFFERENTIATION OF THE DISK FROM THE SURGICAL SCAR TISSUE
BREATH HOLD: QUIET RESPIRATION
SLICE THICKNESS: 2-4 MM ( IF ONE DISK TO SCAN- 2MM)
INDEX: CONTIGUOUS SLICES
START LOCATION: PEDICLE OF C3
END LOCATION: THROUGH C7
FILMING: SOFT TISSUE AND BONE + MPR RECONSTRUCTION (IF SPIRAL)
T-SPINE
SCOUT: LAT
LANDMARK: STERNAL NOTCH
SLICE PLANE: SPIRAL
I.V. CONTRAST: FOR EVALUATION OF DEGENERATIVE DISK DISEASE,
DIFFERENTIATION OF THE DISK FROM THE SURGICAL SCAR TISSUE
BREATH HOLD: QUIET RESPIRATION
SLICE THICKNESS: 3-5 MM
INDEX: CONTIGUOUS SLICES
IF ONE VERTEBRAE
START PEDICLE ABOVE
END LOCATION: PEDICLE BELOW
FILMING: SOFT TISSUE AND BONE + MPR RECONSTRUCTION (IF SPIRAL)
L-SPINE
SCOUT: LAT
LANDMARK: XIPHOID
SLICE PLANE: Angle the gantry so the slices will be parallel to the intervertebral
disk spaces.
I.V. CONTRAST: FOR EVALUATION OF DEGENERATIVE DISK DISEASE,
DIFFERENTIATION OF THE DISK FROM THE SURGICAL SCAR TISSUE
BREATH HOLD: QUIET RESPIRATION
SLICE THICKNESS: 3-5 MM
INDEX: CONTIGUOUS
START LOCATION: PEDICLE OF L3
END LOCATION: S1
FILMING: SOFT TISSUE AND BONE
SCOUT: LAT
LANDMARK: XIPHOID
SLICE PLANE: AXIAL OR SPIRAL
I.V. CONTRAST: FOR EVALUATION OF DEGENERATIVE DISK DISEASE,
DIFFERENTIATION OF THE DISK FROM THE SURGICAL SCAR TISSUE
BREATH HOLD: QUIET RESPIRATION
SLICE THICKNESS: 3-5 MM
INDEX: 3-5 MM
START LOCATION: PEDICLE OF L3
END LOCATION: S1
FILMING: SOFT TISSUE AND BONE + MPR RECONSTRUCTION
3-D RECON: 50% OVERLAP
MYELOGRAPHY
CT MYELOGRAM
PURPOSE OF CT
MYELOGRAM TO DETECT:
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HNP
TUMOR INVADING CANAL
BONY FRAGMENTS IN THE CANAL
CYSTS
IV CONTRAST USED IN CT
MYELOGRAM
• TO DIAGNOSE DEGENERATIVE DISK
DISEASE (EPIDURAL SPACE WILL
ENHANCE)
• DIFFERENTIATION OF THE DISKS
FROM THE SURGICAL SCAR TISSUE
CONTRAST – INTRATHECAL
INJECTION
SCANNING
• 1-4 HOURS AFTER THE CONTRAST
INSTILLED
• THE DELAY ALLOWS FOR CONTRAST
DILUTION SO THE INTRADURAL SPACES
ARE CLEARLY VISUALIZED
• ROLLING OF THE PATIENT BEFORE THE
SCAN PREVENTS LAYERING OF THE
CONTRAST
• PRONE POSITION TO PREVENT POOLING
OF THE CONTRAST
CERVICAL MYELOGRAM
LUMBAR MYELOGRAM
IMAGES