NEURORADIOLOGY - SPINE
NEURORADIOLOGY - SPINEProf. Arif Faisal, Sp.Rad(K),
DHSMYogyakarta, 28 September 2012.
HERNIATION NUCLEUS PULPOSUSProtrusion of disc material > 3 mm
beyond margins of adjecent vertebral endplates involving < 50%
of disc circumference.CAUSERuptur of annulus fibrosus with disc
material confined within posterior longitudinal
ligament.symptomAsymptomatic: 21% populationCentrifugal radiating
pain: sharp, well-circumscribed, superficial, electric, confined to
somatom.Centrifugal referred pain: deep/superficial, ill-defined,
dull, confined to somatome.Local somatic spinal pain: sharp/aching,
deep, localized,locationPosterolateral49%Posterocentral8%Bilateral
(both sides posterior lig)Lateral/foraminal( 50% of circumference-
Disc protrusion: < 50%, wider than tall- Disc extrusion: <
50%, taller than wide
IMAGING MODALITIES1. Plain film : not possible.Bone density,
narrowing disc space, spurring, osteophyte.2. Myelography:
invasive.3. CT/Myelo CT: visualisation nerve roots in the thecal
sac, time-consuming.4. MRI: modality of choice.Sagittal T1w and
T2w.Axial T1w and FSE T2wPLAIN FILM
MYELOGRAPHYSharply indentationAsymetric of posterior disc
marginNarrowing intervertebral disc spaceDeviation of nerve
rootAmputated/truncated nerve root
Multiple herniated disc.
Woman, 69 yrs: LBP & spinal claudication.
Myelo CT:Spinal stenosis L4-L5 & L5-S1.Disc protrusion
(L2-L3)Hyperthrophy ligamentum flava,Facet joint arthritis.cT/Myelo
ctWidth of spinal canal, lateral recess and intervertebral
foramina.Spondylsis, osteophyte, spur & bone
densityProtrusion/herniation density 60-80 HU.Convex bulging at
posterior, laletral border.Compression of nerve rootsSequestrum
CERVICAL REGION
Hyperthropic calcified longitudinal ligament
MYELO CT:Calcified longitudinal ligamentThoracal region
Myelo CT: Th6-Th7 medial disc protrusion.Th11-Th12
intraforaminal disc protrusionLumbar region
Medial disc protrusion L4-L5.L5-S1 disc herniation, left
lateral.
L4-L5 medial disc protrusionL4-L5 intraforaminal disc
protrusion
L4-L5 extraforaminal right disc herniation.L4-L5 infraforaminal
right disc herniation.
L5-S1 left lateral disc hernition, partially calcified. L4-L5
intra/extraforaminal disc herniation, spondylilisthesis .
Free herniated disc fragment.Ruptured annulus fibrosus and
posterior longitudinal ligament with mingration of disc
fragment.Become sequestered, may be surrounded by granulation
tissue.
Sequestered discmriEndplate marrow changes:- T1w hipointensity,
T2w hyperintensity: vascular granulation tissue, enhance.- T1w
hyperintensity, T2w isointense or hyper: fatty marrow replacement.-
T1w hypo, T2w hypo: sclerosisDegenerated discs:- T2w
hypointense.Osteophyte and facet hyperthrophy Hyperthrophy of
ligmentum flavum
T2w : Degenerative disc diseases.-Endplate irregularity
T12-L1-Schmorl node L3-L4.-Hemangioma L1.
T1wi: Severe disc degeneration.- Diffuse endplate
irregularity.
Man, 80 yrs. Sagittal T2w FSE. Concentric disc protrusion,
spondylarthrosis, hypertrhrophy lig. flava.Cauda equina fibers
above stenosis have a typical elongated and wavy appearance.
Woman, 59 yrs. 2 mos after intevertebral disc surgery.Sagittal
T2w TSE. Recurrant disk prolapse.L3-L4.After contrast, peripheral
enhancement of prolapse disc.Axial T2w TSE. Herniated disc on the
right mediolateral side.abc
Axial T2wi:-Disc bulge L5-S1, without focal deformity
Sagittal T1wi:
-Endplate changes L5-S1 Disc psudobulgeT2Wi.
L5-S1 Large extrusion with free fragment, inferior migration.
L4-L5 Small protrusion..
Sagittal T2wi: Extrusion intervertebral disc.
Sagittal T2wi: Limbus herniation, focal contour defect. CT :
Limbus fracture, posterosuperior margin.Spondylitis TB
