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Flashcards in Imaging of spine Deck (34)
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1

When should imaging be employed when patients present with back pain?

Most back pain patients don't require imaging

Need to select patients that have potential for serious instability or neurological damage

2

When is plain film useful for spinal imaging?

Alignment

Fractures

3

When is MRI useful for spinal imaging?

Looking at soft tissue structures 

4

When is CT useful for spinal imaging?

Fractures

Discs

5

Describe the curvatures of the spine?

Cervical and lumbar: lordosis

Thoracic and sacral: kyphosis

 

 

6

Describe the orientation of the facets in the lumbar spine?

Oblique 

 

7

Describe the shape of vertebral bodies in the lumbar spine?

Concavity in lateral, anterior and posterior margins

 

8

Describe what is seen when viewing an X-ray of the anterior lumbar spine?

Thicker cortical bone

Concavity of body

Ring of shadows of cortex of pedicle 

Spinal canal between pedicles 

 

9

Describe why two lines of cortical bine are sometimes seen in imaging of the spine?

 

When cortical margin in oblique to X-ray beam

 

10

Describe what can be seen in an X-ray image of the lateral spine?

Thick and broad spinous process 

Thicker cortical bone

 

11

Describe what can be seen in an oblique X-ray of the spine?

Scotty dog appearance 

 

12

Where is a common fracture site of the spine in young people?

How does it appear on imaging?

Lamina - stress fractures

Neck of Scotty dog 

 

13

Label the features of these X-rays?

 

14

How can intervertebral discs be visualised?

CT (T2 weighted)

MRI

15

Describe the appearance of the intervertebral discs in a T2 weighted C2 image?

Centre of discs appeasr bright 

Strong signal due to water content of nucleus 

 

16

Describe the arrangement of structures exiting the IV foramen?

Nerves superiorly

Small artery

Small nerve

Veins inferiorly 

Surrounded by epidural fat

 

17

Describe the way in which spinal nerves exit the spinal cord?

Cervical: nerve goes out above pedicle of same name

C8 below C7 and above T1

Rest beneath pedicle 

 

18

Which level has this axial image been taken at?

Below L1/L2 (cauda equina visible)

 

19

Which spinal nerve is affected due to lateral protusion of L4/5 disc? Why?

Which spinal nerve is affected due to lateral protusion of L5/S1 disc? Why?

L4/5: Affects L5 spinal nerve, as L4 nerve root has already exited above 

L5/S1: affects S1 spinal nerve, as L5 nerve root has already exited above 

 

20

Between which structures does the ligamentum flavum run?

Between laminae 

 

21

Locate the ALL, PLL and ligamentum flavum in the following images?

22

Which ligaments are visible in axial spinal images?

Don't see ALL and PLL well

Can see ligamentum flavum

 

23

Why is MRI used for spinal imaging?

Discs

Spinal cord

Contents of canal

Nerve roots

24

How are the spinous processes of the thoracic spine different to that of the lumbar spine?

Longer and more inferior direction 

 

25

Why is imaging of the thoracic spine more difficult than the lumbar spine?

Don't see detail as well due to overlying structures 

 

26

What is visible in imaging of the thoracic spine?

Outline of vertebral bodies 

Run down through pedicles

Spinous processes

 

27

What is wrong with this image?

 

Increased kyphosis (due to softening of end plates)

28

Describe this image?

 

Osteophytes in the elderly spine

29

Describe what is wrong with this image?

 

Disc protrusion 

30

Can disc protrusions be visualised with CT?

Yes