NEURORADIOLOGY. Part III. Angela Csomor University of Szeged Department of Radiology
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1 NEURORADIOLOGY Part III Angela Csomor University of Szeged Department of Radiology
2 DISEASES OF SPINE AND SPINAL CORD I. Non-tumourous diseases developmental anomalies vascular disorders inflammatory processes II. Tumours extradural intradural - extramedullary intramedullary degenerative changes trauma
3 SPINE AND SPINAL CORD - imaging methods Plain film radiography Ultrasonography Computer tomography (CT) Magnetic resonance imaging (MRI) Digital subtraction angiography (DSA) Myelography
4 Imaging modalities - indications Plain film radiography developmental anomalies: bone inflammations: spondylitis / spondylodiscitis degenerative: spondylarthrosis trauma: fractures / dislocations tumours: bone changes
5 Imaging modalities - indications Computer tomography (CT) developmental anomalies: bones / spinal canal inflammations: bones / discs degenerative changes: spondylarthrosis, disc herniations trauma: bones, epi - subdural haemorrhages tumours: bone changes Myelo-CT trauma: dural and radicular injuries etc.
6 Imaging modalities - indications Magnetic resonance imaging (MRI) spinal cord lesions: all developmental anomalies vascular disorders inflammatory processes degenerative diseases: disc herniations trauma: intramedullary lesions, haemorrhages tumours
7 Imaging modalities - indications Digital subtraction angiography (DSA) preoperative dg, diff.dg vascular malformations hypervascularized tumours intervention (embolisation) vascular malformations hypervascularised tumours
8 DISEASES OF SPINE AND SPINAL CORD I. Non-tumourous diseases developmental anomalies vascular disorders inflammatory processes II. Tumours extradural intradural - extramedullary intramedullary degenerative changes trauma
9 Developmental anomalies Often complex Involves more structures bones meninges tethered cord, lipoma, spina bifida dermal sinus spinal cord
10 Chiari malformations
11 Developmental anomalies Often complex bones meninges spinal cord Longitudinal split in the spinal cord Osseous/ cartilaginous spur Diastematomyelia with block vertebrae
12 L.V. hypoplasia Developmental anomalies Spondylolisthesis, lysis
13 Developmental anomalies Arachnoidal cyst closed liquor space no CSF flow
14 DISEASES OF SPINE AND SPINAL CORD I. Non-tumourous diseases developmental anomalies vascular disorders inflammatory processes II. Tumours extradural intradural - extramedullary intramedullary degenerative changes trauma
15 Vascular disorders Developmental malformations Dilated, tortuoos veins and stasis Neurological symptomes-slowly Treatment: embolization/surgery Diagnose in early stage! Spinal dural AV fistula
16 Vascular disorders Developmental malformations Cavernoma blood filled vascular spaces
17 Vascular disorders Developmental malformations Acquired Infarcts Vascular territory Symptomes sudden onset progression
18 DISEASES OF SPINE AND SPINAL CORD I. Non-tumourous diseases developmental anomalies vascular disorders inflammatory processes II. Tumours extradural intradural - extramedullary intramedullary degenerative changes trauma
19 Inflammatory processes Spondylitis/spondylodiscitis: two vertebrae and the disc betwen them narrow iv.space irregular vertebral endplates epidural abscess
20 Inflammatory processes Spondylodiscitis Meningitis, abscess Myelitis/ myelopathy
21 Myelopathy pathological conditions of the spinal cord High intensity on T2 Causes Vascular AV fistula, ischaemia Inflammation SM, Devic, ADEM Degenerative cord Compression Trauma Tumor
22 Localisation Diameter Length Enhancement Cord swelling Myelopathy
23 Myelopathy pathological conditions of the spinal cord High intensity on T2 Causes Vascular AV fistula long segmen most of the diameter swelling+ (acut) Ischaemia long segment vascular territory swelling+ (acut)
24 Myelopathy pathological conditions of the spinal cord Causes Inflammation SM, Devic, ADEM less than three segment less than half of the diameter swelling+/- enhancement +/-
25 Neuromyelitis optica Devic Optic neuritis + Myelitis Months / years between them Relapsing, autoimmun long segmen most of the diameter swelling+ (acut) enhancement +/-
26 Acute disseminated encephalomyelitis ADEM After viral infection or vaccination immune mediated Brain and/or spinal cord Multiple Monophasic Usually complete recovery long segmen most of the diameter swelling + enhancement -
27 Myelopathy B12 deficiency Degenerative cord Posterior part, both side
28 DISEASES OF SPINE AND SPINAL CORD I. Non-tumourous diseases developmental anomalies vascular disorders inflammatory processes II. Tumours extradural intradural - extramedullary intramedullary degenerative changes trauma
29 Myelopathy pathological conditions of the spinal cord High intensity on T2 Causes Vascular AV fistula, ischaemia Inflammation SM, Devic, ADEM Degenerative cord Compression Trauma Tumor
30 Degenerative changes Spondylarthrosis Disc herniations Spinal canal, iv. foramen diameter affected bones ligaments disc
31 Degenerative changes
32 Degenerative changes Disc herniations CT MR
33 Degenerative changes Disc herniations - locations medial paramedial lateral (foraminal and extraforaminal)
34 Disc herniation
35 Degenerative changes Disc herniations postoperative scar/residual disc scar enhancement- 2 years Preop. Postop.
36 Pars interarticularis defect Degenerativ spondylosis Spondylolisthesis, lysis
37 DISEASES OF SPINE AND SPINAL CORD I. Non-tumourous diseases developmental anomalies vascular disorders inflammatory processes II. Tumours extradural intradural - extramedullary intramedullary degenerative changes trauma
38 Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
39 CT
40
41 Vertebral compression percutaneous vertebroplasty Metastasis, osteoporosis bone cement is injected fluoroscopic X-ray guidance pain relief vertebral height consolidation
42 Ligamentous injury / instability
43 Atlantoaxial instability
44 Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
45 Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
46 MR Spinal cord compression
47 Trauma/spinal stenosis 1 year later
48 DISEASES OF SPINE AND SPINAL CORD I. Non-tumourous diseases developmental anomalies vascular disorders inflammatory processes II. Tumours extradural intradural - extramedullary intramedullary degenerative changes trauma
49 Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
50 Tumours Extradural bone tumours bone metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
51 Tumours Extradural bone tumours bone metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases Spinal cord compression
52 Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
53 Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas/Neurofibromatosis metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
54 Tumorok Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas/Neurofibromatosis metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases Medulloblastoma drop metastasis
55 Tumours Extradural bone tumours metastases Intradural/extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases Cystic + enhancing part+ syringomyelia
56 Intramedullary astrocytoma
57 Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
58 von Hippel-Lindau disease
59 Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases Melanoma metastases Hodi FS et al. (2008) Nat Clin Pract Oncol doi: /ncponc1183
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