Spinal Imaging. ssregypt.com. Mamdouh Mahfouz MD
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1 Spinal Imaging Degenerative diseases ssregypt.com Mamdouh Mahfouz MD
2 MRI Open MRI Closed
3 Extremity MRI
4 Dynamic MRI Dynamic MRI The bed rotates from Upright to Recumbent, stopping at any angle in between
5 Patient with Low Back Pain After Surgery Dynamic MRI Does a Lie-Down-Only Scanner see the patient s problem? NO! Case courtesy of M. Rose, MD, Rose Radiology Centers
6 Dynamic MRI
7 Surface coils
8 Degenerative diseases 2 7 Spinal canal stenosis Disc lesions Bone marrow changes Ligamentous pathology Osseous changes Spondylolisthesis Cord pathology
9 Spinal canal stenosis Idiopathic type = Reduced sagittal diameter L2 L3 1.1 cm 1.2 cm
10 Spinal canal stenosis Developmental type = Hypertrophied laminae, articular facets and Ligamenta flava
11 Ligamenta Flava hypertrophy
12 Ligamenta Flava hypertrophy L4-5
13 Spinal canal stenosis L4-5 L4-5
14
15 Spinal canal stenosis Idiopathic type = Reduced sagittal diameter Developmental type = Hypertrophied laminae, articular facets and Ligamenta flava L cm
16 L5 Lateral recess spinal canal stenosis 1.4 cm
17 Lumbar spinal canal
18 Spinal canal stenosis Developmental type = Hypertrophied laminae, articular facets and Ligamenta flava
19 Developmental canal stenosis
20 Cervical canal stenosis
21 Cervical canal stenosis
22 Cervical canal stenosis
23 Severe canal stenosis
24 Capacious spinal canal
25 L4-5 Capacious spinal canal L5-S1
26 Disc lesions Degeneration Bulge Herniation
27 Disc Lesions Normal lumbar disc CT L4-5
28 Normal cervical disc CT L4-5 C4-5 L3-4
29 MRI Normal lumbar disc
30 MRI Normal cervical disc
31 Disc lesions L4-5
32 Disc degeneration Loss of water T2 signal [MRI] Loss of height narrowing of disc space [X ray, MR, CT?] Intradiscal air ( vacuum phenomena) [CT]
33 Disc degeneration
34 Disc degeneration
35 Disc lesions
36 Vaccum phenomena
37 Disc lesions Disc bulge = Intact annulus = Diffuse pathology Disc herniation = Torn annulus= Focal pathology Normal L4-5 Bulge
38 Disc Herniation Normal herniation Bulge herniation protrusion Sequest. protrusion Seques t.
39 Disc Herniation
40 Bulge Disc Herniation
41 Bulge Disc Herniation L5-S1 L5-S1
42 Disc bulges
43 Bulge / Herniation
44 Protrusion / herniation
45 Disc Protrusion
46 Disc herniation
47 Disc herniation L4-5
48 Disc herniation
49 Disc herniation
50 Disc herniation
51 Disc herniation L R
52 Disc herniation L R
53 Disc herniation
54 Migration /Sequestration
55 Disc herniation with caudal migration
56 Disc migration
57 Disc migration
58 Disc Sequestration
59 Disc Sequestration
60 Disc and granulation
61 Disc and granulation
![types ] Type I Marrow](/docs-images/85/92214429/images/62-1.jpg "edema Type II Fatty")
62 Bone marrow changes [ Only seen on MRI][3 types ] Type I Marrow edema Type II Fatty marrow
63 Type I Marrow edema
64 Type II Fatty marrow
65 Type II Fatty marrow
66 Type III Bone sclerosis
67 Osseous pathology Osteophytes Anterior Posterior [Important] Osteoarthritis L4-5
68 Osteo -arthritis Narrowing of the joint space Subarticular bone sclerosis Osteophytic lippings Pseudo cystic changes Vacuum phenomena
69 Osteo - arthritis Normal Osteoarthritis
70 Disc /osteophyte complex
71 Ligament pathology Hypertrophy Calcification Ossification
72 Ligamenta flava hypertrophy [ Buckling ]
73 OPLL Ossification of Posterior Longitudinal Ligament
74 OPLL
75 Vertebral displacement Spondylolisthesis [Anterior displacement ] Lytic Degenerative Retrolisthesis [Posterior displacement ]
76 Spondylo - listhesis
77 Spondylo - listhesis Multi-level
78 Spondylo - listhesis [ Pseudo disc bulge ] L4-5 L4 L4 L5
79 Spondylo - listhesis [ Pseudo disc bulge ]
80 Spondylo - listhesis [ Pseudo disc bulge ] L5-S1
81 Spondylo - listhesis [ Multi-level ]
82 Spinal instability
83 Cord pathology Edema Myelomalacia [ early, late] Both produce focal area of low signal in T1 and high signal in T2 Differentiation by clinical presentation of the patient ± contrast injection.
84 Cord pathology Compressive myelomalacia Focal area of high signal in T2 WIs Decompression leads to regression or resolution of early lesions NB: Early lesion shows contrast enhancement
![fragments, [ Trauma]](/docs-images/85/92214429/images/85-2.jpg "Abscesses")
![[inflammatory lesions]](/docs-images/85/92214429/images/85-3.jpg "Neoplastic extra")
85 Para-vertebral shadows Hemorrhage, bone fragments, [ Trauma] Abscesses [inflammatory lesions] Neoplastic extra osseous masses [ Tumors]
86 Q.. Disc herniation, Right postro -lateral
87 Q.. Type II Fatty marrow
88 Q.. Type III Bone sclerosis Lumbar degenerative changes L3-4 disc herniation with cephalic migration L2-3 disc herniation
89 Q.. Disc herniation, left postro -lateral
90 Q.. Disc herniation, left postro -lateral
91 Q.. Lytic Spondylo listhesis with pseudo disc bulge
92 Q.. Type II Fatty marrow
93 Q.. L5-S1 disc herniation with cephalic migration
94 Q.. Disc herniation and granulation
95 Q.. Normal lumbar disc CT Myelography, osteophyte
96 Q.. Sequestrated L4-5 disc with cephalic migration
97 Q.. L5-S1 disc herniation with granulation
98 Q.. Foraminal disc herniation
99 سبحانك اللهم و بحمدك نشهد ان ال اله اال انت نستغفرك و نتوب اليك Thank you
100
101
102
103
104 Degenerative changes Disc lesion
105
106 Multiple disc lesions
107 Cervical discs Lumbar L.flava
108 Lumbar discs & L.flava
109 Canal stenosis Capacious canal,disc
110
111 Disc lesions
112
113
114 ?
115 ?
116 ?
117 ?
118 ?
119 ?
120 ?
121 ?
122 ?
123 ?
124 ? DISC AND GRANULATION
125 ?
126
127 Type II Fatty marrow
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