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MRI of acute spinal trauma
SHIVAPRAKASH.B.H2nd yr RESIDENT
BARNARD INSTITUTE OF RADIOLOGY
To describe various components of spinal injuries on MRI.
To know whether mechanism of injury can be assessed by pattern of injury.
AIM
Anatomy Approach Mechanism of injury
Normal anatomy - Axial
Vertebral body level
Normal anatomy - Axial
Intervertebral disc level
Sagittal
Normal anatomy - Parasagittal
Dennis 3 Column concept
Sections Sequences
Sagittal T1W SE,T2W FSE
Axial T1W SE,T2W FSE
Imaging protocol
Sequences SignificanceFat sat T2W/STIR BONY EDEMA &
INJURY TO INTERSPINOUS LIG
T2W GRE CORD HEMATOMA
Malalignment in sagittal plane, Change in vertebral body contour.
Vertebral injury
To look for It implies
Break in the continuity of the signal void
Vertebral cortex injury
Signal change Haemorrhage and oedema within the vertebral body
Wedge compression injuries
Bands of hyperintensity on T2-weighted images parallel to the end-plate,
Fracture of the superior end-plate,
Buckling of the anterior vertebral body cortex.
D12 wedge compression #
Burst fractures Associated
disruption of the posterior vertebral body cortex.
D12 burst #
Sectional plane To look for
Parasagittal Subluxation and dislocation of the facet joints
Axial images Fractures of the neural arch
C6 – C7 IVD
C7
Anterior longitudinal (ALL), Posterior longitudinal (PLL) and Posterior ligamentous complex (PLC) comprising the ligamentum flavum. (LF), interspinous ligament (ISL),
supraspinous ligament (SSL) and facet joint capsules.
Ligaments of the spine
Rupture Discontinuity of the ligament, Stripping of the intact ligament, Partial avulsion or attenuation of the
ligament and combined osseo-ligamentous injury.
Best identified on T2-weighted images.
Ligament injuries
D11 over D12
D 11 fracture D12 wedge compression #
Intradiscal haemorrhage/oedema, Annular rupture, Avulsion from the end-plate and herniation,
either into the epidural space or into the vertebral body.
Disc injury
D12 #
D11 over D12
Type On T1W On T2W
Type 1 (Intramedullary hematoma)
Depends on age Depends on age
Type 2 (Cord edema)
Diffuse swelling of cord
Diffuse hyperintensity of cord
Type 3 (Mixed lesion)
Small central hypointensity surrounded by flame shaped areas of oedema
Neural injury
Cord hematoma
C5-C6,C7-C8 IVD levels
Cord edema
Transection
C5 over C6
D10 over D11
Focal kyphosis, Abnormal separation of facets/spinous
processes. Evidence of canal compromise and ventral
cord edema.
Hyperflexion injury
C4 over C5
Soft tissue edema in post spinal soft tissue. Edema and disruption of ALL and nuchal
ligament injury.
Hyperextension injuries
C5 over C6
Altered adjacent facetal relationship. Spinous process malalignment. Focal vertebral body kyphosis.
Hyperflexion rotation injury
A perched facet joint, is a vertebral facet joint whose inferior articular process on one side appears to sit 'perched' on the superior articular process of the vertebra below.
Perched facet
Locked facet
Unilateral facet or laminar fracture due to hyperextension with rotation combined causing ligament disruption.
Hyperextension rotation injury
C7
Mimics
MRI is best for assessment of the patient with acute spinal injury.
Careful attention to technique and imaging allows us to complete evaluation of injury to the vertebral column, ligaments, discs and cord.
The array of findings associated with mode of spinal injury allows us conclude about mechanism of injury to spine.
To conclude
Thank you