FOR RESIDENT RADIOLOGIST

By
Ahmad Mokhtar Abodahab
Ass. Lecturer of Radiodiagnosis
Sohag University
Less Likely in Cervical
 CT SPINE
3 Protocols

1- DISC SCAN 2-Screening 3-Selective scanning

Scans
pass
along the
disc
SCOUT in Scoliosis is coronal
 Spine

Is simply formed by , connection between

Bones vertebrae : 7C - 12D - 5L - 5S - 4 Cox
Discs
Ligaments :
- Ant. Long - Post Long - Flava - Inter spinous - Supra Spinous

- Inter transverse
 Anterior
perivertebral
soft tissue
thickness = not
exceed width
of vertebral
body

Lines of CS fractures Calcification

 Craniovertebral
angle
=Angle formed by:
- Basilar line and
-Posterior tangent to C2
Normal range :
150 (flexion) to 180
(extension)
spinal compression
occurs at less than
150.
* Atlantodental distance:
a -Sagittal plane:
13 mm
(up to 5 mm in children)
b -Coronal and axial
planes: dens is centere Chamberlains line

Height of intervertebral disk s:

* C2 < C3 < C4 < C5 < C6 ! C7
 Chamberlains line :

=line connecting:
- Posterior border of hard palate with
- Posterior rim of the foramen magnum):
Tip of the dens should project not more than 1
mm
6.6 mm above the line
 (= AB/C D):
Between 0.5 and 0.22 = normal
(< 0.22 = spinal stenosis)

http://jpma.org.pk/full_article_text.php?article_id=56
67
 Disc height
increased downward
from T1 : L5
 1 Lumbosacral
angle
(S1/horizontal
plane) = 26 : 56
2 Height of lumbar
disks:
Approx. = 812 mm,
increasing from L1
to L4/5
L5-S1 :
Fish Mouth Like
 1- 12th rib
2-Zygapophysial (facet)
joint L I L II
3- Superior articular
process of L III
4- Pedicle of vertebral arch
L III (eye of Scottie dog)
5- Transverse process of L
III (snout of Scottie dog)
6- Superior articular
process of sacrum
7- Inferior articular
process of L II
8- Transverse process of L
III
9- Zygapophysial (facet)
joint L II L III
10- Lamina of vertebral
arch L IV
 CT density of
intervertebral
disks: 70 5 HU

Lateral recess
(sagittal diameter):
> 5 mm

Ligamenta flava:
Width < 6 mm
SPINAL
DEGENERATIVE
DISEASE
Degenerative diseases
1
2
3
1. Spinal canal stenosis
4
2. Disc lesions 5 7
3. Bone marrow changes
4. Ligamentous pathology
6
5. Osseous changes
6. Spondylolisthesis
7. Cord pathology
 3
Idiopathic = Reduced sagittal diameter

Developmental = Hypertrophied
laminae,
articular facets and
Ligamenta flava

Acquired= Disc lesions, osteophytes,

L2
 Acquired &
Developmental
Developmental canal stenosis
Disc lesions

Degeneration:
Dehydration
Reduced Height
Vacuum
Calcefication
Bulge
Herniation
Cervical spinal canal

Normal mild moderate Severe

MRI
Normal
lumbar
disc
 In patients with symptoms of nerve root compression, there are four levels that need to
be studied:
1- Disc level.
- The most common .
- Mostly by herniated discs
- Less frequently due to spinal stenosis.
2- Level of lateral recess.
- Area below the disc
- Nerve runs more laterally towards the foramen.
- By facet arthrosis, usually + hypertrophy of the flavum ligament and bulging of the
disc.
3- Foramen.
Area between two pedicles, where the nerve leaves the spinal canal.
Narrowing of the foramen is seen in :
* facet arthrosis, * spondylolisthesis and * foraminal disc herniation - usually a migrated
disc from a lower level.
4- Extra-foraminal.
This is the area lateral to the foramen.
Nerve compression in this area is uncommon,
but is sometimes caused by a laterally herniated disc.
 Disc bulge/ Herniation
Disc bulge= Intact annulus = Diffuse pathology
Disc herniation= Torn annulus= Focal pathology

Normal

L4-5

Bulge
 Disc bulge/ Herniation
Disc herniation = Torn annulus = Focal pathology
Protrusion
Migration
Sequestration

Sequest. Bulge

Normal

herniation protrusion
HERNIATION PROTRUSION
 CT

L4/5

Disc bulge Disc herniation

 CT

Normal lumbar disc

 Focal Vs Diffuse
 Migration and Sequestration
Causes of Foraminal stenosis:
Facet arthrosis
Disc herniation with upward migration
Spondylolistesis
Foraminal Disc Herniation
 frequently seen in combination with facet
arthrosis.

Mostly they lead to stenosis of the lateral

facet.

When very large they can protrude into the

foramen and cause foraminal stenosis.
A case of Synovial Cyst

Sagital T2 WI
Axial T2WI of the same case
 Synovial
cyst
can mimimc
Normal
Foramen
Notice ,
nerve is not
seen
Other causes of Spinal canal
Compression :
Fractures
Mets
3- Bone marrow
degenerative changes [ MRI]
Type I marrow edema Low signal T1+ high signal T2

Type II fatty conversion High signal T1+ Low signal T2

Type III bone sclerosis Low signal T1+ Low signal T2

4- Osseous pathology
Osteophytes
Anterior

Posterior (more important)

Osteoarthritis

L4-5
Other lesions
[ osteoarthritis]
Narrowing of the joint space
Subarticular bone sclerosis
Osteophytic lippings
Pseudo cystic changes
Vacuum phenomena
 joint space

sclerosis

NORMAL FACET
LIPING

VACUUM
Psudo Cysts
 5- Ligamentous pathology

Hypertrophy
calcification
Ossification
 *

OPL
6- Vertebral displacement
Spondylolisthesis[ anterior displacement ]
Lytic
Degenerative
Retrolisthesis [ posterior displacement ]
Retrolisthesis
 * Common
* Less common

Spinal cord abnormalities

Type II Fatty marrow
Vacuum Phenomenon
Modic type 1
Bone Mets compressing spinal
canal
 Schmorl's
nodule
A.M.Abodahab
29 August 2015