Ebook Critical observations in radiology for medical students: Part 2
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Ebook Critical observations in radiology for medical students: Part 2
CHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2epirumtu OÍ Radkdogy, Lnfrcnily of North Caroiiru. Chrpd HUI. USAIntroductionSpine pathology can be grossly divided into degenerative and non-degenerative diseases that may be clinically indistinguishable as symptoms commonly overlap. Patients with spine disorders may present with focal or diffuse b Ebook Critical observations in radiology for medical students: Part 2ack pain, radiculopathy, or myelopathy. Myelopathy describes any neurologic deficits related to disease in the spinal cord while radiculopathy generalEbook Critical observations in radiology for medical students: Part 2
ly results from impingement of the spinal nerves along their course. Focal back pain without neurologic compromise or fever is not usually an emergencCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2deficits accompany them, immediate imaging is indicated. When the history and physical findings are nonspecific, as frequently they arc in clinical practice, imaging findings become central to the diagnosis and treatment.Imaging modalitiesConventional radiography was the initial imaging procedure in Ebook Critical observations in radiology for medical students: Part 2 spine evaluation, but with computes! tomography (CD and magnetic resonance imaging (MR1) now widely available, radiographs are no longer considered aEbook Critical observations in radiology for medical students: Part 2
dequate. Radiographs are still useful for acute trauma screening, for localization purposes during surgery procedures (plain films and fluoroscopy), aCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2yelography.Spinal CT is the modality of choice for evaluation of the bone structures and calcifications, while MRI is better to evaluate the details of spinal anatomy, including the intraspmal contents (spinal cord, conus medullarii and cauda equina, dural sac epidural, subdural and subarachnoid spa Ebook Critical observations in radiology for medical students: Part 2ces), neural foramina, yoints, ligaments, intervertebral discs, and bone marrow. Sagittal and axial images should be acquired through the cervical, thEbook Critical observations in radiology for medical students: Part 2
oracic, and lumbar segments of the spine, as they are generally considered complementary. The addition of coronal images may also be useful, especiallCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2ich include short tail inversion recovery (STIR) or fat-saturated T2-weighted sequences), complemented by postcontrast Tl-WI if tumor, inflammation, infection, or vascular diseases are suspected.Diffusion-weighted imaging (DWI) IS challenging in the spine, largely due to physiological cerebrospinal Ebook Critical observations in radiology for medical students: Part 2fluid (CSF) flow-induced artifact and distortion from magnetic susceptibilities. It has been used in the diagnosis of spinal cord infarct. Similar toEbook Critical observations in radiology for medical students: Part 2
the brain, spinal cord infarcts show restricted diffusion, seen as bright lesions on DWI with low signal on apparent diffusion coefficient (ADC) maps.CHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2ains controversial.Diffusion tensor imaging (DTI) evaluates the direction and magnitude of extracellular water molecules movement within the white matter fibers and enables the visualization of the mayor white matter tracts in the brain and spine, spine DTI has been used to evaluate the integrity of Ebook Critical observations in radiology for medical students: Part 2 the extent of neural damage in patients with acute or chronic spinal cord injury and also to distinguish between infiltrative and localized tumors beEbook Critical observations in radiology for medical students: Part 2
cause the latter arc easier to resect.Nuclear medicine bone scans and PET7CT are used to screen the entire skeleton for metastasis. They are highly seCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2, except during surgery after removal of the posterior elements. In this setting, it may be used to image the spina) cord. However, in neonates, the nonossified posterior elements provide the acoustic window through which the spinal anomalies can be readily evaluated.Conventional digital subtraction Ebook Critical observations in radiology for medical students: Part 2 angiography (DSA) can be performed for spinal vasculature evaluation, since spina) CT and MR angiography arc difficult to interpret and have limitedEbook Critical observations in radiology for medical students: Part 2
application. The major indications for spinal DSA arc evaluation of suspected arteriovenous fistulas (AVF), arteriovenous malformations, and localizatCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2sircdd). *od Riiturd c. Scroelki. O20IS lohn Wifcy & Sons. lad. Published 2015 by lotin Wile) & Sons. lid.Companion wtbsilc: www.wllcy.som'pa'birehMd116Appearance of the normal spine studyVertebral anatomy varies somewhat by region, but the bask components are the same as follows:•Vertebral body wit Ebook Critical observations in radiology for medical students: Part 2h vertebral end plates that define the interver tebral space, which contains the interverteliral disc•Musterior vertebral arch that includes a pair ofEbook Critical observations in radiology for medical students: Part 2
pedicles, a pair of laminae, and 7 processes: 2 superior articular processes, 2 inferior articular processes, 2 transverse processes, and 1 posteriorCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2also known as the axis, are unique, t he other cervical vertebrae are similar in size and configuration. Cl is a ring-shaped vertebra, composed of anterior and posterior arches and two lateral articular masses, without a central vertebral body. The vertebral arteries commonly traverse the lateral ma Ebook Critical observations in radiology for medical students: Part 2sses of Cl. C2 is also a ring shaped vertebra but has a central body and a superiorly oriented odontoid process, akoknown as the dens, which lies postEbook Critical observations in radiology for medical students: Part 2
erior Io the anterior arch of Cl. The normal distance between the dens and anterior arch of c 1 is approximately 3 mm in adults and 4 mm in children aCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2joints formed by the articulation of the uncinate process between two adja cent vertebral bodies, rhe transverse foramen (also known as the fimunen tnuiswrsarium) located in the transverse processes of the cervical vertebrae gives passage to the vertebral artery, the vertebral vein, and a plexus of Ebook Critical observations in radiology for medical students: Part 2sympathetic nerves generally from C6 up to Cl.The discs of the cervical and thoracic spine are much thinner compared with the lumbar discs. In the lumEbook Critical observations in radiology for medical students: Part 2
bar spine, the posterior margins of the discs tend to be slightly concave at upper levels, straight at 1.4/5 level, and slightly convex at the lumbosaCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2ment (ALL), posterior longitudinal ligament (Pl.l.).and posterior ligamentous complex (PLC) that include the supraspinous and inter-spinous ligaments, articular facet capsules, and ligament um Ịlavum.The spinal canal contains the thecal sac formed by the dura mater and surrounded by the epidural S]x Ebook Critical observations in radiology for medical students: Part 2*ce. which contains epidural fat and a large venous plexus. The thecal sac houses the spinal cord, unntf medidiaris, and cuuda UỊUÍnư (lower lumbar anEbook Critical observations in radiology for medical students: Part 2
d sacral nerve roots), surrounded by fredy flowing CSF within the subarachnoid space.The spinal cord is composed of a core of gray matter surrounded bCHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2e by a commissure, rhe conus mcduUaris normally ends around 1.1 1.2 vertebral level. The ftlutn terminate is a strand of pial-epcndymal tissues, proceeding downward from the apex of the CONNS medullarii fo the coccyx.Throughout the spine, the intervertebral foramina, or neural foramina, contain the Ebook Critical observations in radiology for medical students: Part 2nerve roots and its sleeve, the dorsal nxil ganglion, fat. and blood vessels.On MRI. the appearance of different structures varies according Io the seEbook Critical observations in radiology for medical students: Part 2
quence used. The vertebral body contains bone marrow, which signal varies with age, reflecting the gradual conversion of red marrow to fatty' marrow. CHAPTER 7Spine imagingJoana N. Ramalho'J and Mauricio Castillo1' IScpaitmeni oếNeuroradlology. Centro Ikupiukr de lisboo Central. 1-obou. ỈVxt^Ịál Ufe Ebook Critical observations in radiology for medical students: Part 2on therapy, increased hematopoiesis, or any disease that affects I lie bone marrow may alter the normal bone marrow signal. Peripherally, tlx; bone marrow is surrounded by low T1 - and T2-WI signal of the cortical bone. Intervertebral discs demonstrate slightly less signal than the adjacent vertebra Ebook Critical observations in radiology for medical students: Part 2l bodies on Tl-WI,but the differentiation of the centrally located nucleus pulpcwus and peripheral annulus fibrosis of the discs is difficult on thisEbook Critical observations in radiology for medical students: Part 2
sequence On T2-WI, the normally hydrated nucleus pulposus composed of water and proteoglycans shows high signal centrally with lower signal from the lGọi ngay
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