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Indications and Preparations for MRI and CT in Spinal Imaging

MRI and CT scans are vital for diagnosing conditions affecting the spine, including disc lesions, post-operative evaluations, tumors, degenerative diseases, trauma, and congenital abnormalities. Preparation for these imaging tests includes fasting for 4-6 hours and, when necessary, the administration of contrast materials like Urographin. Positioning of patients is typically supine, though other positions may be used. Understanding the typical imaging techniques and structures to evaluate, including spinal canal diameter and disc morphology, is crucial for accurate diagnosis and treatment planning.

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Indications and Preparations for MRI and CT in Spinal Imaging

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  1. What are the indications for MRI & CT: Disc lesions Post-operative spine(after surgery) Tumors Any degenerative disease Trauma Congenital abnormalities of the spine

  2. Preparations for CT & MRI:1-Fasting for 4-6 hours2-Contrast material Urographin ,telebrix 1-2 mg/kg • Administration of contrast: Yes: In post-operative lumbar spine, inflammatory disorders& neoplastic lesions. No:disc lesions, trauma. Anesthesia Used with children & uncooperative patients.

  3. Patient position: Is usually supine, sometimes side lying, & rarely prone.   How to see: Scanogram: primitive picture to detect the site of lumbar spine

  4. Computed tomography (CT): . Usual scanning. . Axial slides 2-4 mm. 2 mm in cervical spine / 4 mm in lumbar spine Has bone & soft tissue window. CT screening: . Whole segment of the spine 5 mm in cervical spine, 8 mm in lumbar spine. . Selective Scanning Every 3 mm especially in trauma, also in cervical disc lesions. N.B: If I want to see one vertebra e.g. L3 I have to take 1 vertebra above (L2 )& 1 below (L4).

  5. CT Myelography: • Is considered as intrathecal contrast injection with L- puncture needle. • We have 2 windows • Soft tissue & bone window. What are the structures I should evaluate in CT of lumbar spine: • Lumbar spinal canal diameter normally 13 mm. • Disc lesions. • Others. • facet, sacroiliac joints & paravertebral soft tissue.

  6. Soft &bone window (CT) Lumbar

  7. 1. Lumbar spinal canal diameter: Spinal canal is bony structure, so we see it in bone window. The spinal canal must be closed (at the level of pedicles). We measure the AP diameter. Types of canal stenosis: 1-Relative: 11-12 mm & this doesn’t need operation but it needs operation if there’s disc. 2- Absolute: 8 -10 mm & it must be operated.

  8. Disc lesions: We detect it in soft tissue window. Posterior border of the disc is more important as it has relation to the disc. The normal posterior border of the disc is CONCAVE. The abnormal is STRAIGHT OR CONVEX.

  9. N.B: . Normally due to overload ,the disc of L5-S1 is CONVEX& the abnormal is also convex,so to judge if it’s normal or no look at the next slide if: the posterior border of the disc is convex so it is ABNORMAL. . The angle of inclination in L5-S1 is more than 30 & the device accept up till 30 only so part of the slide will contain bone & part will contain disc.

  10. Normal CT Lumbar

  11. Disc bulge(CT axial)

  12. MRI – LUMBAR SPINEM NERVE ROOTS FORAMEN AXIAL VIEW

  13. Manifestations of arthritis in any joint: (Spondylosis in spine and osteoarthritis of other joints) • Osteophytic lipping. • Narrow joint space. • Subarticular bone sclerosis • Sub cortical pseudo cystic changes. • Intra articular air.(vaccum phenomena)

  14. Vacuum phenomena

  15. CT of cervical spine

  16. We have 2 types of joints: • Neurocentral joint: Is the articulation between one vertebra above & one vertebra below which makes the shape of the body of the vertebral end plate . • Facet joint: Is the articulation between the inferior lip of the transverse process of one vertebra above with the superior lip of the transverse process of the vertebra below, it’s called Hamburger’s Sandwich. Arthritis of the neurocentral or facet joint gives the same manifestations of nerve compression due to disc lesion.

  17. Cervical disc in CT: • We see it in soft tissue window .The disc in cervical spine is very narrow so every slide will contain both disc & bone, therefore there isn’t a slide of pure disc, So we choose the slide which contain more disc for assessment. . All posterior edges of cervical spine are normally convex. . See if there’s disc substance protruded than the bone. . Normal spinal cord picture is kidney shaped.

  18. Difference between cervical & lumbar spine in CT

  19. Stages of disc pathology (4 stages)

  20. CT of the spine

  21. CT axial bone& soft tissue widow

  22. CT machine

  23. MRI CT plain x-Ray

  24. CT– CERVICAL SPINE C2-3 INTERVERTEBRAL DISC FORAMEN DISC FORAMEN FACET JOINT FACET JOINT SPINOUS PROCESS AXIAL SAGITTAL

  25. CT- CERVICAL SPINE C-1 SECTION ARCH OF C-1 DENS BASE OF SKULL MASTOID AXIAL SAGITTAL

  26. CT- LUMBAR SPINE POST MYELOGRAM DISC SPINOUS PROCESS

  27. CT– CERVICAL SPINE C- 3 SECTION PEDICLE PEDICLE LAMINA AXIAL SAGITTAL

  28. CT-- CERVICAL SPINE C-2 SECTION C-2 BODY DEGENERATED C6-7 C-2 SPINOUS PROCESS AXIAL SAGITTAL

  29. CT axial CT sagittal

  30. CT- LUMBAR SPINE POST MYELOGRAM Axial PEDICLE PEDICLE NERVE ROOTS

  31. Posterior arch #(CT)

  32. Burst # (CT) axial

  33. sagittal CT

  34. CT axial section (base of the skull)

  35. CT- LUMBAR SPINE POST MYELOGRAM FORAMEN FORAMEN

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