Hidayatullah Hamidi. MD Consultant Radiologist. Lumbar Spine MR Imaging Interpretation

Transcription

1 Hidayatullah Hamidi. MD Consultant Radiologist Lumbar Spine MR Imaging Interpretation 13/12/2018

2 Presenter Hidayatullah Hamidi Consultant Radiologist, Radiology PGME program director, FMIC, Kabul, Afghanistan Residency: FMIC Training/Scholarship/Fellowships: Pakistan, Austria, Turkey Conference presentations: Iran, Pakistan, Austria, Turkey, Afghanistan Scientific publications: >30 in international journals >150 radiology cases in Radiopaedia, the largest radiology online portal Google scholar: Researchgate: Radiopaedia: Orcid ID: Website: Mobile (whatsapp, Viber):

3 Outlines How to read an MRI exam MR anatomy of the spine Spine degenerative disease Spine infections

4 Case I 41-year-old lady with low back pain

5 Case 2 32-year-old man with low back pain for last one month

6 Case 3 55-year-old man with chronic low back pain

7 Case 4 65 year old man with low back pain. History of Prostate neoplasm

8 Case 5

9 Case 6 40-year-old man with history of lower limb weakness for last 6 months

10 Case 7

11 Case 8

12 Case 9 32-year-old man with low back pain. No history of trauma.

13 How to read an MRI exam 1

14 Magnetic resonance imaging Large, powerful magnet where patient lies. Radio wave antenna: send signals to body and receive back. Computer converting signals into images Tesla

15 Advantages No ionising radiation Multiplane imaging (axial, sagittal, coronal, or oblique) Superior tissue contrast Angiography without contrast (TOF) Advanced techniques: diffusion, spectroscopy, perfusion

16 Disadvantages Cost and availability Longer time, sedation/anesthesia in children Noise and claustrophobia Metal implants and foreign bodies Pregnancy

17 Planes

18 Sequences T1 T2 +Contrast Fat saturated STIR Others After recognizing the sequences you know what to expect from each sequence

19 Signal Charecteristics Of Different Tissue Components CSF/fluid Fat Muscles Disc Cortex Bone marrow

20 Signal Charecteristics Of Different Tissue Components

21 Terms Signal Intensity Iso-intense Hyper intense Hypo intense High signal Intermediate signal Low signal Fat/Fluid/Soft tissue intensity

22 Indications Degenerative disease Congenital anomalies Infections Trauma Neoplasms and metastasis

23 MRI Anatomy of the Spine 2

24 How to read a lumbar spine MRI

25 How to read a lumbar spine MRI

26 Go systematically; Follow chick list 1. Alignment: lordosis 2. Vertebral body: number, shape 3. End plates 4. Posterior arches 5. Conus medullaris 6. Disc: height, margins and signal 7. Spinal canal width and margins

27 Go systematically; Follow chick list 8. Lateral recesses >4 5mm 9. Ligamentum flavum <6mm

28 Go systematically; Follow chick list 10. Neural foramina White fat pad and dark nerve root

29 Go systematically; Follow chick list 11. Facet joints 12. Spinous processes 13. Bone marrow 14. Soft tissues

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31 Degenerative Spine Disease 3

32 Entities Included Disc Dehydration Disc Bulge and herniation Annular tear Endplate changes Facet arthropathy Ligamentum flavum hypertrophy

33 Disc Dehydration Components of disc Annulus fibrosis Nucleus pulpous Black disc (Discogenic pain syndrome)

34 Annular Tear Damaged structural integrity of posterior annulus fibrosus

35 Disc Bulge and Herniation Displacement of disc material beyond the limits of disc space. Bulge: >50% Herniation: <50% Protrusion Extrusion

36 Location of disc herniation

37

38 Migrating and Sequestrated disc

39 Intravertebral disc herniation

40 Limbus vertebra

41 Endplates changes Inflammation Fatty replacement Sclerosis T1 T2 Modic I Modic II Modic III

42 Facet Arthropathy

43 Ligamentum flavum hypertrophy

44 Spondylolisthesis

45 Degenerative Spinal Canal Stenosis Normal width Relative stenosis: Absolute stenosis: 16 18mm 11 15mm <10 mm

46 Clinical remarks The relation between low-back pain and abnormalities in the lumbar spine is controversial as abnormal findings are often seen in asymptomatic patients. Degenerative changes in the disc are already seen in 1/3 of healthy persons between 21 and 40 years old.

47 Spine infections 4

48 Spine infections Begins from disc End-plate destruction Abscess formation Bone marrow edema Tuberculosic versus Pyogenic Location Enhancement pattern

49 Few more common entities 4

50 Hemangioma

51 Focal fatty deposits in spinal bone marrow

52 Gas in the vertebral disc

53 Case I 41-year-old lady with low back pain

54 Case 2 32-year-old man with low back pain for last one month

55 Case 3 55-year-old man with chronic low back pain

56 Case 4 65 year old man with low back pain. History of Prostate neoplasm

57 Case 5

58 Case 6 40-year-old man with history of lower limb weakness for last 6 months

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64 Case 7

65 Case 8

66 Case 9 32-year-old man with low back pain. No history of trauma.

67 Take home message Lumbar spine interpretation is essential for every clinician Go systematically In the degenerative spine, the imaging findings may not correlate with clinical condition. TREAT THE PATIENT NOT THE FILM

68 Acknowledgments Most of the CT images are from Author s department. Some cases are taken from Grainger & Allison Diagnostic Radiology, that is hereby acknowledged.

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