1. Magnetic resonance imaging (MRI) plays an important role in evaluating acute spinal trauma by detecting injuries that may be missed on other imaging studies like CT scans or x-rays.
2. MRI is better than other imaging modalities at identifying ligamentous injuries, disc herniations, epidural hematomas, and spinal cord injuries which are important to evaluate spinal stability and guide management.
3. The typical MRI protocol for acute spinal trauma includes sagittal and axial T1-weighted, T2-weighted, STIR, and T2* gradient echo sequences to fully characterize bone fractures, disc abnormalities, cord injuries, ligamentous injuries, and hemorrhage.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
SWI , high susceptibility for blood products, iron depositions, and calcifications
makes susceptibility-weighted imaging an important additional sequence for the diagnostic
workup of pediatric brain pathologic abnormalities. Compared with conventional MRI
sequences, susceptibility-weighted imaging may show lesions in better detail or with higher
sensitivity
Anatomy of Brain by MRI
In this presentation we will discuss the cross sectional anatomy of brain. Then we will discuss the Most common diseases to be evaluated by brain imaging.
In my opinion this presentation is a road map for beginars.
Physicians have used palpation to detect differences in tissue stiffness as an aid to diagnosis based on the fact that the mechanical properties of tissues are often dramatically affected by the presence of disease processes such as cancer, inflammation, and fibrosis. Elastography depends on the same differences in mechanical properties between healthy and abnormal tissues using imaging to detect these differences at depths not reachable by manual palpation and presents data in color-coded display, can be performed with ultrasound, using manual pressure or low frequency sonic waves, or by MR Elastography imaging.
SWI , high susceptibility for blood products, iron depositions, and calcifications
makes susceptibility-weighted imaging an important additional sequence for the diagnostic
workup of pediatric brain pathologic abnormalities. Compared with conventional MRI
sequences, susceptibility-weighted imaging may show lesions in better detail or with higher
sensitivity
Anatomy of Brain by MRI
In this presentation we will discuss the cross sectional anatomy of brain. Then we will discuss the Most common diseases to be evaluated by brain imaging.
In my opinion this presentation is a road map for beginars.
Physicians have used palpation to detect differences in tissue stiffness as an aid to diagnosis based on the fact that the mechanical properties of tissues are often dramatically affected by the presence of disease processes such as cancer, inflammation, and fibrosis. Elastography depends on the same differences in mechanical properties between healthy and abnormal tissues using imaging to detect these differences at depths not reachable by manual palpation and presents data in color-coded display, can be performed with ultrasound, using manual pressure or low frequency sonic waves, or by MR Elastography imaging.
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
This is an old article circa 2002 that is an excellant overview of selective spinal immobilization. Since I am having trouble finding it online anymore, I put it here for all to read and enjoy. I did not write it nor do I came any copywrite for it.
MRI offers a great aid in diagnosis of abnormal placentation. This presentation describes the normal MRI appearance of the placenta and the MRI signs of placental adhesion disorders.
Low back pain is a common health problem and imaging is pivotal in its assessment. Most lesions can be diagnosed by MRI. The nomenclature of disc lesions is also presented.
iodinated and gadolinium Contrast media are widely used in imaging. The radiologist and the physician should be familiar with the common side effects and the serious life threatening adverse reactions,
The solitary lung nodule. A diagnostic dilemma. hazem youssef
Incidentally discovered pulmonary nodule are a diagnostic challenge. This presentation is focused on the different features of lung nodules and their management.
Introduction to trauma imaging. Guidelines and highlights for different imagi...hazem youssef
Early imaging, rather than admission and observation for neurological deterioration, will reduce time to detection for life threatening complications and is associated with better outcomes
The implementation of MDCT in urological imaging has solved much of the diagnostic dilemma. Thanks to its multiplanar capabilities and post processing techniques.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Role of magnetic resonance Imaging in acute spinal trauma
1. ROLE OF MAGNETIC
RESONANCE IMAGING IN ACUTE
SPINAL TRAUMA
HERRE TO ADD TEXT
Dr. Hazem Abu Zeid Yousef TO ADD TEXT
2. Trauma to the spinal column and spinal cord are
potentially devastating injuries.
Approximately half the spinal cord injuries occur
from motor vehicle crashes. Falls from height,
gunshot wounds, motorcycle crashes, crush
injuries, and medical/surgical complications
account for most of the remaining cases .
3. Imaging is a major pillar in the evaluation of
the trauma patient in addition to the history
and physical examination.
5. Only one third of spinal trauma patients present
initially with a neurological deficit
Moreover, important clinical features such as pain
from injury may be masked by other injuries,
medication, and drug and alcohol intoxication
Defining the group of subjects who are at risk for
cervical spine fracture and therefore in whom imaging
is appropriate remains challenging.
6. The NEXUS study indicates that cervical spine imaging is not necessary in
trauma patients who meet all of the following five criteria:
1. No midline cervical spine tenderness
2. No focal neurological deficit
3. Normal level of alertness
4. No intoxication
5. No painful distracting injury
NEXUS - National Emergency X-Ray Utilization Study, United States, published in 2000
Source: Hoffman J, Mower W, Wolfson A, et al. Validity of a set of clinical criteria to rule out
injury to the cervical spine in patients with blunt trauma. N Eng J Med. 2000;343:94–99.
sensitivity - 99.6%
specificity - 12.6%
7. Canadian C-Spine Rule for selective ordering of cervical spine imaging
Stiell, I. G et al. BMJ 2009;339:b4146
99.4% - sensitivity
45.1% - specificity
8. According to American College of Radiology (ACR)
appropriateness criteria, MRI of spine combined with CT scan is
appropriate in the setting of acute spinal trauma if :
1. NEXUS or Canadian Cervical-Spine Rule criteria are met and
there are clinical findings of myelopathy.
2.NEXUS or CCR criteria are met and there are clinical or
imaging findings to suggest ligamentous injury.
3.NEXUS or CCR criteria indicate imaging and the mechanically
unstable spine is anticipated.
Daffner RH, Hackney DB. ACR Appropriateness Criteria on suspected spine trauma. J Am Coll
Radiol. 2007;4:762–75.
9. RADIOGRAPHY for primary cervical spine
screening
• Minimum standard views
– Lateral through C7
– AP
– Odontoid
• Supplementary views
• Bilateral obliques
– Swimmer’s
– Flex ion and extension
10.
11.
12.
13. 1 = anterior vertebral line
2 = posterior vertebral line
3 = spinolaminar line
4 = posterior spinous line
NORMAL CERVICAL SPINENORMAL CERVICAL SPINE
RP
14. Predental spacePredental space • 3mm or less
(4-5mm in children)
C2-C3 pseudosubluxationC2-C3 pseudosubluxation • 3mm or less
(4-5mm in children)
Retropharyngeal spaceRetropharyngeal space • < 6mm at C2
• < 22mm at C6
• For children 1/2 to 2/3
vertebral body distance
anteroposteriorly
Angulation of spinal column atAngulation of spinal column at
any single interspace levelany single interspace level
• < 11 degrees
Cord dimensionCord dimension • 10-13mm
Cervical Spines NormsCervical Spines Norms
15. GCS below 13 on initial assessment.
Has been intubated.
Plain film series is technically inadequate (for
example, desired view unavailable), suspicious or
definitely abnormal.
Continued clinical suspicion of injury despite a
normal X-ray.
The patient is being scanned for multi-region trauma.
Who gets CT
16. CT versus Radiography
Vandermark claimed:Vandermark claimed:
Well positioned and optimally exposed radiographs discloseWell positioned and optimally exposed radiographs disclose
95% of clinically significant C-spine fractures.95% of clinically significant C-spine fractures.
However –However – these high quality studies are often impossible tothese high quality studies are often impossible to
obtainobtain andand pt’s at highest risk are most likely to havept’s at highest risk are most likely to have
technically compromised imaging.technically compromised imaging.
1996 Nunez et al1996 Nunez et al 40% of Fx’s40% of Fx’s missed on radmissed on rad later revealed onlater revealed on
CTCT . One third of them had clinically significant or unstable. One third of them had clinically significant or unstable
Fx’sFx’s
Vandemark RM. Radiology of the cervical spine in trauma patients: practice pitfalls
and recommendations for improving efficiency and communication. AJR 1990;
155:465 –472
17. • Multidetector CT
– Faster.
– More Sensitive.
– Cost effective/more
expensive.
• Conventional Rad
– Slower.
– Less sensitive.
– Less expensive.
So, which do you choose?
18. Who Gets MRI?
1.Radiographic and/or CT scan findings suggestive of ligamentous
injury, such as prevertebral hematoma, spondylolisthesis,
asymmetric disc space widening, facet joint widening or
dislocations, and inter-spinous space widening.
2.To look for epidural hematoma or disc herniation before
attempting a closed reduction of cervical facet dislocations.
3.To identify spinal cord abnormalities in patients with impaired
neurological status.
4.To exclude clinically suspected ligamentous or occult bony
injuries in patients with negative radiographs.
5.To determine the stability of the cervical spine and assess the
need for cervical collar in obtunded trauma patients.
6.To differentiate between hemorrhagic and non-hemorrhagic
spinal cord injuries for the prognostic significance.
19. Kumar and Hayashi BMC Musculoskeletal Disorders (2016) 17:310
DOI 10.1186/s12891-016-1169-6
20. The typical MRI protocol for spinal
injury includes:
Sagittal T1W images for depiction of anatomy and osseous
fractures,
Sagittal T2W images for detecting the cord edema,
Sagittal T2*W (GRE) images to detect the hemorrhage in and
around the cord,
Sagittal STIR images which are very sensitive for detection
of edema and is helpful in diagnosing the soft tissue and
ligamentous injuries, particularly of the interspinous or
supraspinous ligaments,
And axial T2W and T2*W GRE sequences.
24. Stable vs unstable fracture
The most important radiological finding to
suggest spinal instability is the involvement
of two columns, based on the Denis
classification as described above, which
includes middle column in most cases.
25. Other imaging findings of instability:
translation of greater than 2 mm
widening of the facet joints and interspinous space,
disruption of the posterior vertebral body line,
greater than 50 % loss of vertebral body height,
and greater than 20 degrees of kyphosis.
CT is sufficient to demonstrate most of these
findings, but is insensitive for the detection of
ligamentous injuries.
26. Types and mechanisms of ligamentous
injury
Spinal ligaments are very important to maintain the normal
alignment between vertebral segments under a physiologic load.
Normal ligaments of the spine appear as low signal intensity
bands on all the sequences .
27.
28. Ligamentous tears can be partial or complete. Partial
tears are seen as high signal areas on STIR images with
varying degrees of intact fibers. Complete tears are seen
as complete lack of intact fibers. Types of ligamentous
injury is usually related to the mechanism of the trauma.
Hyperextension injuries usually result in damages to the
anterior column or combined anterior and posterior
columns and thus involving the ALL and PLL.
However, hyperflexion injuries can also result in
posterior column or combined posterior and middle
columns injuries characterized by damages to
ligamentum flavum, interspinous ligaments,
supraspinous ligaments, facet joint capsules, and PLL.
29.
30.
31. Acute traumatic disc herniation
Traumatic disc herniations are most commonly
associated with vertebral fracture dislocations and
hyperextension injuries of the spine, and are caused
by injuries to annulus fibrosus with nucleus pulposus
herniation.
Axial GRE can differentiate herniated disk material
(which is hyperintense on GRE) and osteophytes
(which are hypointense) .
32.
33. Extra medullary hemorrhage
Extradural hematoma is the most common type of
extra medullary collections in trauma patients.
Subdural hematoma and subarachnoid hemorrhage
are uncommon. Epidural hematomas usually appear
isointense to slightly hyperintense on T1W images
and hyperintense on T2W images. In GRE images
epidural hematoma has low signal intensity .
34.
35. Vascular injuries
Vascular injuries can be caused by both blunt and
penetrating trauma. In blunt vascular injuries in the
neck, vertebral arteries are more commonly
involved than carotid arteries. The Denver
screening criteria has been used to identify the
patients at risk for vascular injuries and includes
C1–C3 fractures, fracture of the cervical spine
extending into a foramen transversarium, cervical
spine subluxation, Le Fort II or III facial fractures,
basilar skull base fractures involving the carotid
canal, diffuse axonal injury, and expanding neck
hematoma.
36. The imaging findings of vascular injuries include
minimal intimal injury, visualization of intimal flap,
pseudoaneurysm, dissection with intramural
hematoma, complete occlusion, active extravasation,
and arteriovenous fistula formation. Most of the
vascular injuries can be seen as irregularity or loss
of normal flow void on long TE sequences such as
T2W images. In equivocal cases, CT angiography or
catheter angiography can be used for further
evaluation of vascular injuries.
37.
38. Spinal cord injuries
In MRI assessment of spinal cord injury, the axial and
sagittal T2W images, and T2*W GRE images are
particularly useful. Most common MRI findings of
cord trauma include abnormal hyperintense T2 signal
suggesting cord edema, hypointense signal depicting
hemorrhage “best seen on GRE images”, and a
mixture of edema and hemorrhage. Although
neurological function at the presentation remains the
single best predictive factor for long term prognosis,
presence of cord hemorrhage has been described as the
most important findings associated with poor
prognosis.
39.
40.
41. Other osseous and soft tissue injuries
Osseous injuries with little apparent morphologic
changes such as compression and cortical break are
difficult to be diagnosed with CT. MRI is very sensitive
for detection of these occult osseous injuries by showing
marrow edema as hyperintense signal on STIR images.
Prevertebral soft tissue injuries can occur and may
demonstrate abnormal thickening. Paraspinal muscles
injuries can also occur with trauma, either in isolation or
associated with other injuries.
42.
43.
44. Old vs acute vertebral fracture
Compression vertebral fractures are very common,
especially in the elderly, and are usually osteoporotic .
MRI can be very helpful by showing the bone marrow
edema “low signal on T1W images and high signal on
T2W and STIR images”. Soft tissue edema associated
with acute compression fractures can also be an
important differentiating clue. The chronic fractures
will show fatty marrow as high signal on T1W and
T2W images without marrow edema.
45.
46. Benign osteoporotic fracture vs malignant
fracture
Differentiating acute osteoporotic fractures from acute
pathological fractures caused by metastases and other
primary malignancies is a commonly encountered
dilemma in the clinical practice.
47. MRI findings favouring acute osteoporotic
compression fractures:
1) horizontal band of abnormal signal intensity
separated by a straight line from the normal fatty
marrow,
2) relative lack of involvement of posterior
elements,
3) and angulated and concave appearance of the
posterior vertebral margin.
48.
49. Pathological fractures due to malignancy on MRI
are characterized by
1) involvement of the entire vertebral body by
abnormal bone marrow edema,
2) extension into posterior elements,
3) convex appearance of the posterior vertebral
wall,
4) involvement of the surrounding soft tissue,
5) and the presence of other bony lesions.
50.
51. Diffusion weighted imaging also has been shown to be
useful in differentiating these two by showing restricted
diffusion in malignant pathological fractures. This has
been attributed to the high cellularity and high
nucleocytoplasmic ratio in rapidly dividing tumor cells.