Spinal Imaging

Breakdown of Vertebrae 7 12 5 5 FUSED http://www.anatomyatlases.org/bonebox/spine.shtml

Curvature Four Curves Convex or Concave Aka Lordotic/Kyphotic Primary – thoracic/pelvic Secondary (compensatory) – cervical/lumbar

Four Curves

Convex or Concave

Aka Lordotic/Kyphotic

Primary – thoracic/pelvic

Secondary (compensatory) – cervical/lumbar

Kyphosis-Lordosis-Scoliosis Kyphosis – increased curve of thoracic Lordosis – increased curve of lumbar Scoliosis – an abnormal lateral curvature (Ant. View)

Kyphosis – increased curve of thoracic

Lordosis – increased curve of lumbar

Scoliosis – an abnormal lateral curvature (Ant. View)

Typical Anatomy Body & vertebral arch create the vertebral foramen ¼ of column are intervertebral disks Nucleus pulpous can rupture HNP 1 st two cervical vertebrae are not typical for articulation with the skull

Body & vertebral arch create the vertebral foramen

¼ of column are intervertebral disks

Nucleus pulpous can rupture

HNP

1 st two cervical vertebrae are not typical for articulation with the skull

Cervical Spine

Cervical Spine CERVICAL SPINE Transverse process of C-1 (Atlas )

Typical Cervical Vertebrae C3 – C6 – C7 Small oblong bodies Short wide transverse processes contain foramen Vertebral artery & vein Pedicles project laterally & posteriorly Laminae narrow and thin Spinous processes are short

C3 – C6 – C7

Small oblong bodies

Short wide transverse processes contain foramen

Vertebral artery & vein

Pedicles project laterally & posteriorly

Laminae narrow and thin

Spinous processes are short

C3 –C6 BIFID SPINOUS PROCESS

Typical Cervical Vertebra 1- Spinous process 5- Neural foramen 2- Lamina 6- Body 3- Pedicle 4- Transverse foramen 1 2 3 4 6 5

C1 CERVICAL SPINE/BONE ATYPICAL VERTEBRAS, C-1, C2 & C-7 C-1

C/SPINE 1 st SLICE START ABOVE THE C/SPINE 1- OCCIPITAL BONE 2- FORAMEN MAGNUM 1 2

C- 1 THE ATLAS 1 2 3 4 1- Anterior arch 2- Transverse foramen 3- Odontoid process 4- Transverse process

C- 1 THE ATLAS 1 2 3 1- Anterior tubercle 2- Posterior arch 3- Posterior tubercle

C2 Vert. Axial Cross Section (superior view) Superior Articular Facet Dens/Odontoid Transverse Process Lamina Verterbral Column Spinous Process

C- 2 THE AXIS 1- Dens or Odontoid 2- Spinous Process 1 2

C1/2

7 th Cervical vertebra Spinous process long and prominent C7 has longer spinous process called the prominens

Coronal MPR 1 2 3 4 5 1- Dens 2- Lateral mass of C1 3- Body of C2 4- Inferior Articular Process 5- Anterior Articular Process 6- Facet Joint 6

Coronal MPR OD LM B TP

Soft Tissue 1 2 3 1- Facet Joint 2- Cord 3- Sternocleidomastoid muscle

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE Pharynx – funnel shaped muscular tube that acts as an opening for both respiration and the digestive systems. (3) Sections: Nasopharynx – most superior Oropharynx – posterior ext. of oral cavity Laryngopharynx – extends from oropharynx to the esophagus

Pharynx – funnel shaped muscular tube that acts as an opening for both respiration and the digestive systems.

(3) Sections:

Nasopharynx – most superior

Oropharynx – posterior ext. of oral cavity

Laryngopharynx – extends from oropharynx to the esophagus

Sagittal MPR

Sagittal MPR 1 2 1- Facet Joint (Zygapophyseal Joints) 2- Intervertebral Foramen

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT NECK/AXIAL

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

CT/NECK CORONAL C2 C-7

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE Larynx – located at C4/C5 behind the thyroid & cricoid cartilages @ the upper end of the trachea. The larynx (plural larynges ), colloquially known as the voicebox , is an organ in the neck of mammals involved in protection of the trachea and sound production. The larynx houses the vocal folds , and is situated just below where the tract of the pharynx splits into the trachea and the esophagus .

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE Thyroid – situated on either side of the larynx and trachea. (joined by an isthmus) Each lobe is approx. 5cm long and 3cm wide Larger in peds. The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck inferior to (below) the mouth and at approximately the same level as the cricoid cartilage . The thyroid controls how quickly the body burns energy , makes proteins , and how sensitive the body should be to other hormones .

Thyroid – situated on either side of the larynx and trachea. (joined by an isthmus)

Each lobe is approx. 5cm long and 3cm wide

Larger in peds.

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE EPIGLOTIS - The epiglottis is a lid-like flap of elastic cartilage tissue covered with a mucus membrane , attached to the root of the tongue . It projects obliquely upwards behind the tongue and the hyoid bone.

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE ESOPHAGUS – muscular tube extending down to the cardiac orifice of the stomach. The esophagus (also spelled oesophagus / œsophagus , Greek οἰσοφάγος), or gullet is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach .

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE ESOPHAGUS

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE Gastroesophageal Reflux Disease ( GERD or GORD using the British œsophageal ) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus [1] .

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE Anatomy . the usually movable organ in the floor of the mouth in humans and most vertebrates, functioning in eating, in tasting, and, in humans, in speaking. TONGUE hypoglossal

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE Adenoids (or pharyngeal tonsils , or nasopharyngeal tonsils ) are a mass of lymphoid tissue situated at the very back of the nose, in the roof of the nasopharynx , where the nose blends into the mouth .

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE The uvula ( pronounced /ˈjuːvjələ/) is a small, mucosa-covered set of muscles, musculus uvulae , hanging down from the soft palate , near the back of the throat . The word is derived from the diminutive of uva , the Latin word for "grape", due to the uvula's grape-like shape.

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE The soft palate (or velum , or muscular palate ) is the soft tissue constituting the back of the roof of the mouth . The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone

SOFT TISSUE NECK CERVICAL SPINE/SOFT TISSUE VOCAL CORDS- True Cords – inferior pair False Cords – superior pair Voice box: The voice box, or larynx, is the portion of the respiratory (breathing) tract containing the vocal cords which produce sound. It is located between the pharynx and the trachea. The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck.

LYMPH NODES CERVICAL SPINE/SOFT TISSUE Hodgkin's lymphoma , also known as Hodgkin's disease , is a type of lymphoma first described by Thomas Hodgkin in 1832. Hodgkin's lymphoma is characterized clinically by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. Pathologically, the disease is characterized by the presence of Reed-Sternberg cells . Hodgkin's lymphoma was one of the first cancers to be cured by radiation. Later it was one of the first to be cured by combination chemotherapy . The cure rate is about 93%, making it one of the most curable forms of cancer.

SALIVARY GLANDS The salivary glands in mammals are exocrine glands that produce saliva . In other taxa such as insects , salivary glands are often used to produce biologically important proteins such as silk or glues

ROUTINE C/SPINE WITH MDCT YOU SPIRAL AND DO AXIAL RECON THRU DISK SPACE Parameters Single Slice 4 SLICE 16 SLICE PATIENT HEAD FIRST. SUPINE SAME SAME SCANNING AREA OCCIPITAL- T1 SAME SAME CONTRAST 100ML AT 1- 2ML/SEC SAME SAME DETECTOR COLLI NA 1MM 0.75 DFOV NONE 1 OR 2.5 MM 0.75MM SLICE THICKNESS 3 MM SAME 2-4 MM ANGLE PARALLEL TO DISK SPACE NONE SAME TABLE FEED/ROT 3MM VARIABLE SAME PITCH 1-1.5 VARIABLE SAME ROT TIME 1-2 SEC 0.75SEC SAME RECON SOFT TISSUE/BONE SAME SAME WINDOW 500W/50L 1500-300L/ 2000-3000w SAME SAME

THORASIC SPINE

Thoracic Spine

T-Vertebrae Thoracic Vertebrae The twelve thoracic vertebrates form the basic anchor of the rib cage which joins together with the spinal column in the posterior skeletal anatomical design. These vertebrates are larger than the previous vertebra, the cervical vertebra, and increase in size as they go down the spine. Every individual thoracic vertebra is designed with a lengthy spinous process which slopes gently downward. They are also individually equipped with facets, in order to securely connect with the ribs.

Thoracic Vertebrae The twelve thoracic vertebrates form the basic anchor of the rib cage which joins together with the spinal column in the posterior skeletal anatomical design. These vertebrates are larger than the previous vertebra, the cervical vertebra, and increase in size as they go down the spine. Every individual thoracic vertebra is designed with a lengthy spinous process which slopes gently downward. They are also individually equipped with facets, in order to securely connect with the ribs.

Rib articulations

1 2 3 1- CLAVICLE 2- FACET JOINT 3- RIB

1 2 3 1- Sternum 2- SC Joint 3- Clavicle

1 2 3 1- Sternum 2- Ribs 3- Scapula

1- Costal facet on body 2- Costal Facet on transverse process 2 1

1 2 3 4 1- Disk 2- Superior Articular process 3- Joint 4- Inferior Articular process

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

CT THORASIC AXIAL

1 2 3 4 1- Intervertbral foramen 2- Inferior articular notch 3- Superior articular notch 4- Disk space

1 2 1- Costal Joint 2- Joint between Vertebrates

L-SPINE GROSS ANATOMY

L-SPINE GROSS ANATOMY

LATERAL VIEW

L-SPINE GROSS ANATOMY

BONE STRUCTURE

Anatomy of a HNP

ROUTINE L/SPINE WITH MDCT YOU SPIRAL AND DO AXIAL RECON THRU DISK SPACE Parameters Single Slice 4 SLICE 16 SLICE PATIENT FEET FIRST. SUPINE SAME SAME SCANNING AREA T12- COCCYX SAME SAME CONTRAST 100ML AT 1- 2ML/SEC SAME SAME DETECTOR COLLI NA 1MM 0.75 DFOV 23-25 CM SAME SAME SLICE THICKNESS 14 MM SAME SAME ANGLE PARALLEL TO DISK SPACE NONE SAME TABLE FEED/ROT 3MM VARIABLE SAME PITCH 1-1.5 VARIABLE SAME ROT TIME 1-3 SEC 0.75SEC SAME RECON SOFT TISSUE/BONE SAME SAME WINDOW 500W/50L 1500-300L/ 2000-3000w SAME SAME

L-SPINE 1 2 3 4 5 1- SPINAL BODY 2- SPINAL CORD 3- LAMINA 4- SPINOUS PROCESS 5- AORTA

L-SPINE 1 2 1- TRANSVERSE PROCESS 2- POSAS MUSCLE

L-SPINE 1 2 3 4 1- LATERAL MASS OF SCARUM 2- ILLUM 3- SCAROILLIAC JOINT 4- SCARAL FORAMINA

1 2 3 4 5 6 BONE WINDOWS 1- NEURAL FORAMEN 2- APOPHYSEAL JOINT 3- INF ARTICULAR PROCESS 4- VERTEBRAL FORAMEN 5- PEDICLE 6- SUP ARTICULAR PROCESS

1- LAMINA 2- SPINOUS PROCESS 1 2 BONE WINDOWS

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

CT LUMBAR AXIAL

BONE WINDOWS 1 1- S.I. JOINTS

SAGITAL REFORMAT 1 2 3 4 5

CORONAL REFORMAT 1 2 3 4 5

L- spine VRT

ROUTINE L/SPINE WITH MDCT YOU SPIRAL AND DO AXIAL RECON THRU DISK SPACE Parameters Single Slice 4 SLICE 16 SLICE PATIENT FEET FIRST. SUPINE SAME SAME SCANNING AREA T12- COCCYX SAME SAME CONTRAST 100ML AT 1- 2ML/SEC SAME SAME DETECTOR COLLI NA 1MM 0.75 DFOV 23-25 CM SAME SAME SLICE THICKNESS 14 MM SAME SAME ANGLE PARALLEL TO DISK SPACE NONE SAME TABLE FEED/ROT 3MM VARIABLE SAME PITCH 1-1.5 VARIABLE SAME ROT TIME 1-3 SEC 0.75SEC SAME RECON SOFT TISSUE/BONE SAME SAME WINDOW 500W/50L 1500-300L/ 2000-3000w SAME SAME

B L SP P R CVJ CTJ

SP B PM

ZJ

F SIJ

Pathologies http://www.med-ed.virginia.edu/courses/rad/cspine/index.html http://www.gentili.net/fracturemain.asp#

Ankylosing spondylitis is a type of arthritis that affects the spine. Spondylitis may cause pain and stiffness from the neck down to the lower back. The bones of the spine, called vertebrae, may grow or fuse together, resulting in a rigid spine. These changes may be mild or severe, and may lead to a stooped-over posture.

Spondylolisthesis Description The most common X-ray identified cause of low back pain in adolescent athletes is a stress fracture in one of the bones (vertebrae) that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects the fifth lumbar vertebra in the lower back, and much less commonly, the fourth lumbar vertebra. If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis). If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition

HNP-herniated nucleus pulposus

Many types of tumors start in the central nervous system (CNS) (brain and spinal cord). If you have one of these tumors, your symptoms, outlook for survival (prognosis), and treatment depend on your age, the tumor type, and the precise location of the tumor within the CNS Astrocytoma: Most tumors that arise within the brain itself start in brain cells called astrocytes . These tumors are called astrocytomas. About 35% of brain tumors are astrocytomas. Most astrocytomas cannot be cured because they spread widely throughout the surrounding normal brain tissue. Sometimes astrocytomas spread along the cerebrospinal fluid pathways. With only rare exceptions, astrocytomas, however, do not spread outside of the brain or spinal cord

Astrocytoma

Definition Lumbar Spinal Stenosis is derived from the word stenosis meaning narrowing. Imagine the spinal canal is a circle. The circle can be average, big or small. Since the spinal nerves travel in the circle at this level of the spine, any narrowing of the circle could put pressure on the spinal nerves. Unless the individual is born with a small spinal canal (congenital stenosis), spinal narrowing occurs most commonly from progressive degenerative changes (acquired spinal stenosis).

Spine stenosis

Fractures- Jefferson’s A Jefferson fracture consists of a fracture of the C1 ring. This results from an axial loading injury to the head with compression force to C1 (typically from diving).

Hangman’s fracture- C2-C3 Unstable hangman's type fracture of the C2 body and posterior elements extending into the left foramen transversarium.

COMPRESSION FRACTURE

BURST FRACTURE Burst fractures are comminuted fractures of the vertebral bodies often associated with bone fragments in the canal

VACUUM “GAS” PHENOMENON Vacuum" phenomena relate to the accumulation of gas, principally nitrogen, in crevices within the intervertebral disk or vertebra.

Protocols

C-SPINE

SCOUT: LAT LANDMARK: XIPHOID SLICE PLANE: OML I.V. CONTRAST: FOR EVALUATION OF DEGENERATIVE DISK DISEASE, DIFFERENTIATION OF THE DISK FROM THE SURGICAL SCAR TISSUE BREATH HOLD: QUIET RESPIRATION SLICE THICKNESS: 2-4 MM ( IF ONE DISK TO SCAN- 2MM) INDEX: CONTIGUOUS SLICES START LOCATION: PEDICLE OF C3 END LOCATION: THROUGH C7 FILMING: SOFT TISSUE AND BONE + MPR RECONSTRUCTION (IF SPIRAL)

T-SPINE

SCOUT: LAT LANDMARK: STERNAL NOTCH SLICE PLANE: SPIRAL I.V. CONTRAST: FOR EVALUATION OF DEGENERATIVE DISK DISEASE, DIFFERENTIATION OF THE DISK FROM THE SURGICAL SCAR TISSUE BREATH HOLD: QUIET RESPIRATION SLICE THICKNESS: 3-5 MM INDEX: CONTIGUOUS SLICES IF ONE VERTEBRAE START PEDICLE ABOVE END LOCATION: PEDICLE BELOW FILMING: SOFT TISSUE AND BONE + MPR RECONSTRUCTION (IF SPIRAL)

L-SPINE

SCOUT: LAT LANDMARK: XIPHOID SLICE PLANE: Angle the gantry so the slices will be parallel to the intervertebral disk spaces. I.V. CONTRAST: FOR EVALUATION OF DEGENERATIVE DISK DISEASE, DIFFERENTIATION OF THE DISK FROM THE SURGICAL SCAR TISSUE BREATH HOLD: QUIET RESPIRATION SLICE THICKNESS: 3-5 MM INDEX: CONTIGUOUS START LOCATION: PEDICLE OF L3 END LOCATION: S1 FILMING: SOFT TISSUE AND BONE

Proper Position

SCOUT: LAT LANDMARK: XIPHOID SLICE PLANE: AXIAL OR SPIRAL I.V. CONTRAST: FOR EVALUATION OF DEGENERATIVE DISK DISEASE, DIFFERENTIATION OF THE DISK FROM THE SURGICAL SCAR TISSUE BREATH HOLD: QUIET RESPIRATION SLICE THICKNESS: 3-5 MM INDEX: 3-5 MM START LOCATION: PEDICLE OF L3 END LOCATION: S1 FILMING: SOFT TISSUE AND BONE + MPR RECONSTRUCTION 3-D RECON: 50% OVERLAP

MYELOGRAPHY

CT MYELOGRAM

PURPOSE OF CT MYELOGRAM TO DETECT: HNP TUMOR INVADING CANAL BONY FRAGMENTS IN THE CANAL CYSTS

HNP

TUMOR INVADING CANAL

BONY FRAGMENTS IN THE CANAL

CYSTS

IV CONTRAST USED IN CT MYELOGRAM TO DIAGNOSE DEGENERATIVE DISK DISEASE (EPIDURAL SPACE WILL ENHANCE) DIFFERENTIATION OF THE DISKS FROM THE SURGICAL SCAR TISSUE

TO DIAGNOSE DEGENERATIVE DISK DISEASE (EPIDURAL SPACE WILL ENHANCE)

DIFFERENTIATION OF THE DISKS FROM THE SURGICAL SCAR TISSUE

CONTRAST – INTRATHECAL INJECTION

SCANNING 1-4 HOURS AFTER THE CONTRAST INSTILLED THE DELAY ALLOWS FOR CONTRAST DILUTION SO THE INTRADURAL SPACES ARE CLEARLY VISUALIZED ROLLING OF THE PATIENT BEFORE THE SCAN PREVENTS LAYERING OF THE CONTRAST PRONE POSITION TO PREVENT POOLING OF THE CONTRAST

1-4 HOURS AFTER THE CONTRAST INSTILLED

THE DELAY ALLOWS FOR CONTRAST DILUTION SO THE INTRADURAL SPACES ARE CLEARLY VISUALIZED

ROLLING OF THE PATIENT BEFORE THE SCAN PREVENTS LAYERING OF THE CONTRAST

PRONE POSITION TO PREVENT POOLING OF THE CONTRAST

CERVICAL MYELOGRAM

LUMBAR MYELOGRAM