NEURORADIOLOGY Part III Angela Csomor University of Szeged Department of Radiology
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
SPINE AND SPINAL CORD - imaging methods Plain film radiography Ultrasonography Computer tomography (CT) Magnetic resonance imaging (MRI) Digital subtraction angiography (DSA) Myelography
Imaging modalities - indications Plain film radiography developmental anomalies: bone inflammations: spondylitis / spondylodiscitis degenerative: spondylarthrosis trauma: fractures / dislocations tumours: bone changes
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.
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
Imaging modalities - indications Digital subtraction angiography (DSA) preoperative dg, diff.dg vascular malformations hypervascularized tumours intervention (embolisation) vascular malformations hypervascularised tumours
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
Developmental anomalies Often complex Involves more structures bones meninges tethered cord, lipoma, spina bifida dermal sinus spinal cord
Chiari malformations
Developmental anomalies Often complex bones meninges spinal cord Longitudinal split in the spinal cord Osseous/ cartilaginous spur Diastematomyelia with block vertebrae
L.V. hypoplasia Developmental anomalies Spondylolisthesis, lysis
Developmental anomalies Arachnoidal cyst closed liquor space no CSF flow
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
Vascular disorders Developmental malformations Dilated, tortuoos veins and stasis Neurological symptomes-slowly Treatment: embolization/surgery Diagnose in early stage! Spinal dural AV fistula
Vascular disorders Developmental malformations Cavernoma blood filled vascular spaces
Vascular disorders Developmental malformations Acquired Infarcts Vascular territory Symptomes sudden onset progression
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
Inflammatory processes Spondylitis/spondylodiscitis: two vertebrae and the disc betwen them narrow iv.space irregular vertebral endplates epidural abscess
Inflammatory processes Spondylodiscitis Meningitis, abscess Myelitis/ myelopathy
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
Localisation Diameter Length Enhancement Cord swelling Myelopathy
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)
Myelopathy pathological conditions of the spinal cord Causes Inflammation SM, Devic, ADEM less than three segment less than half of the diameter swelling+/- enhancement +/-
Neuromyelitis optica Devic Optic neuritis + Myelitis Months / years between them Relapsing, autoimmun long segmen most of the diameter swelling+ (acut) enhancement +/-
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 -
Myelopathy B12 deficiency Degenerative cord Posterior part, both side
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
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
Degenerative changes Spondylarthrosis Disc herniations Spinal canal, iv. foramen diameter affected bones ligaments disc
Degenerative changes
Degenerative changes Disc herniations CT MR
Degenerative changes Disc herniations - locations medial paramedial lateral (foraminal and extraforaminal)
Disc herniation
Degenerative changes Disc herniations postoperative scar/residual disc scar enhancement- 2 years Preop. Postop.
Pars interarticularis defect Degenerativ spondylosis Spondylolisthesis, lysis
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
Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
CT
Vertebral compression percutaneous vertebroplasty Metastasis, osteoporosis bone cement is injected fluoroscopic X-ray guidance pain relief vertebral height consolidation
Ligamentous injury / instability
Atlantoaxial instability
Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
MR Spinal cord compression
Trauma/spinal stenosis 1 year later
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
Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
Tumours Extradural bone tumours bone metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
Tumours Extradural bone tumours bone metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases Spinal cord compression
Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas/Neurofibromatosis metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
Tumorok Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas/Neurofibromatosis metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases Medulloblastoma drop metastasis
Tumours Extradural bone tumours metastases Intradural/extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases Cystic + enhancing part+ syringomyelia
Intramedullary astrocytoma
Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas Neurinomas metastases Intramedullary astrocytomas ependymomas Haemangioblastomas metastases
von Hippel-Lindau disease
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:10.1038/ncponc1183