Ct&Mri

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CT & MRI

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Ct&Mri

  1. 1. What are the indications for MRI & CT: <br />Disc lesions<br />Post-operative spine(after surgery)<br />Tumors<br />Any degenerative disease<br />Trauma<br />Congenital abnormalities of the spine<br /> <br />
  2. 2. Preparations for CT & MRI:1-Fasting for 4-6 hours2-Contrast material Urographin ,telebrix 1-2 mg/kg<br />Administration of contrast:<br />Yes: In post-operative lumbar spine, inflammatory disorders& neoplastic lesions.<br />No:disc lesions, trauma.<br />Anesthesia<br />Used with children & uncooperative patients. <br />
  3. 3. Patient position:<br /> Is usually supine, sometimes side lying, & rarely prone.  <br />How to see:<br />Scanogram: primitive picture to detect the site of lumbar spine<br /> <br />
  4. 4. Computed tomography (CT):<br />. Usual scanning.<br /> . Axial slides 2-4 mm.<br /> 2 mm in cervical spine / 4 mm in lumbar spine<br />Has bone & soft tissue window.<br /> CT screening:<br />. Whole segment of the spine<br /> 5 mm in cervical spine, 8 mm in lumbar spine.<br />. Selective Scanning<br /> Every 3 mm especially in trauma, also in cervical disc lesions. <br />N.B:<br />If I want to see one vertebra e.g. L3 I have to take 1 vertebra above (L2 )& 1 below (L4).<br />
  5. 5.
  6. 6.
  7. 7. CT Myelography:<br /><ul><li>Is considered as intrathecal contrast injection with L- puncture needle.
  8. 8. We have 2 windows
  9. 9. Soft tissue & bone window.</li></ul>What are the structures I should evaluate in CT of lumbar spine:<br />Lumbar spinal canal diameter normally 13 mm.<br />Disc lesions.<br />Others.<br />facet, sacroiliac joints & paravertebral soft tissue.<br />
  10. 10. Soft &bone window (CT) Lumbar<br />
  11. 11.
  12. 12. 1. Lumbar spinal canal diameter:<br />Spinal canal is bony structure, so we see it in bone window.<br />The spinal canal must be closed (at the level of pedicles).<br />We measure the AP diameter. <br />Types of canal stenosis:<br />1-Relative:<br />11-12 mm & this doesn’t need operation but it needs operation if there’s disc.<br />2- Absolute:<br /> 8 -10 mm & it must be operated.<br /> <br />
  13. 13. Disc lesions:<br />We detect it in soft tissue window.<br /> Posterior border of the disc is more important as it has relation to the disc.<br /> The normal posterior border of the disc is CONCAVE.<br />The abnormal is STRAIGHT OR CONVEX.<br />
  14. 14. N.B:<br />. 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.<br />. 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.<br />
  15. 15.
  16. 16.
  17. 17. Normal CT Lumbar<br />
  18. 18. Disc herniation (CT axial)<br />
  19. 19. MRI – LUMBAR SPINEM<br />NERVE ROOTS<br />FORAMEN<br />AXIAL VIEW<br />
  20. 20. Manifestations of arthritis in any joint:<br /> (Spondylosis in spine and osteoarthritis of other joints)<br />Osteophytic lipping.<br />Narrow joint space.<br />Subarticular bone sclerosis<br />Sub cortical pseudo cystic changes.<br />Intra articular air.(vaccum phenomena)<br />
  21. 21. Vacuum phenomena<br />
  22. 22. CT of cervical spine<br />
  23. 23. We have 2 types of joints:<br />Neurocentral joint:<br />Is the articulation between one vertebra above & one vertebra below which makes the shape of the body of the vertebral end plate .<br />Facet joint:<br />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.<br /> Arthritis of the neurocentral or facet joint gives the same manifestations of nerve compression due to disc lesion.<br />
  24. 24. Cervical disc in CT:<br />We see it in soft tissue window <br />.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.<br />. All posterior edges of cervical spine are normally convex.<br />. See if there’s disc substance protruded than the bone.<br />. Normal spinal cord picture is kidney shaped.<br /> <br />
  25. 25. Difference between cervical & lumbar spine in CT <br />
  26. 26.
  27. 27.
  28. 28.
  29. 29. Stages of disc pathology (4 stages)<br />
  30. 30. CT of the spine<br />
  31. 31. CT axial bone& soft tissue widow<br />
  32. 32.
  33. 33. CT machine<br />
  34. 34.
  35. 35.
  36. 36.
  37. 37.
  38. 38.
  39. 39.
  40. 40. MRI CT plain x-Ray <br />
  41. 41. CT– CERVICAL SPINE<br />C2-3 INTERVERTEBRAL DISC <br />FORAMEN<br />DISC<br />FORAMEN<br />FACET JOINT<br />FACET JOINT<br />SPINOUS PROCESS<br />AXIAL<br />SAGITTAL<br />
  42. 42. CT- CERVICAL SPINE<br />C-1 SECTION<br />ARCH OF C-1<br />DENS<br />BASE OF SKULL<br />MASTOID<br />AXIAL<br />SAGITTAL<br />
  43. 43. CT- LUMBAR SPINE<br />POST MYELOGRAM <br />DISC<br />SPINOUS PROCESS<br />
  44. 44. CT– CERVICAL SPINE<br />C- 3 SECTION<br />PEDICLE<br />PEDICLE<br />LAMINA<br />AXIAL<br />SAGITTAL<br />
  45. 45. CT-- CERVICAL SPINE<br />C-2 SECTION<br />C-2 BODY<br />DEGENERATED<br />C6-7<br />C-2 SPINOUS PROCESS<br />AXIAL<br />SAGITTAL<br />
  46. 46. CT axial CT sagittal <br />
  47. 47. CT- LUMBAR SPINE<br />POST MYELOGRAM<br />Axial<br />PEDICLE<br />PEDICLE<br />NERVE ROOTS<br />
  48. 48. Posterior arch #(CT)<br />
  49. 49. Burst # (CT) axial<br />
  50. 50. sagittal CT<br />
  51. 51. CT axial section (base of the skull)<br />
  52. 52. CT- LUMBAR SPINE<br />POST MYELOGRAM<br />FORAMEN<br />FORAMEN<br />
  53. 53. CT of cervical spine(sagittal)<br />
  54. 54. CT axial<br />
  55. 55. CT of cervical spine (axial)<br />
  56. 56. CT sagittal <br />
  57. 57. CT sagittal tear drop # dislocation<br />Tear drop # dislocation(plain)<br />
  58. 58. CT-LUMBAR SPINE<br />POST MYELOGRAM<br />THECAL SAC<br />LAMINA<br />LAMINA<br />
  59. 59. CT- LUMBAR SPINE<br />POST MYELOGRAM<br />FACET JOINTS<br />
  60. 60. CT- LUMBAR SPINE<br />POST MYELOGRAM<br />PEDICLE<br />PEDICLE<br />NERVE ROOTS<br />

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