What are the indications for MRI & CT
1. What are the indications for MRI & CT:What are the indications for MRI & CT:
Post-operative spine(after surgery)
Any degenerative disease
Congenital abnormalities of the spine
1-Fasting for 4-6 hours
2-Contrast material Urographin ,telebrix 1-2
• Administration of contrast:
Yes: In post-operative lumbar spine,
inflammatory disorders& neoplastic lesions.
No: disc lesions, trauma.
Used with children & uncooperative patients.
Is usually supine, sometimes side lying, &
How to see:
Scanogram: primitive picture to detect the
site of lumbar spine
. Usual scanning.
. Axial slides 2-4 mm.
2 mm in cervical spine / 4 mm in lumbar spine
Has bone & soft tissue window.
. Whole segment of the spine
5 mm in cervical spine, 8 mm in lumbar spine.
. Selective Scanning
Every 3 mm especially in trauma, also in cervical
If I want to see one vertebra e.g. L3 I have to take 1
vertebra above (L2 )& 1 below (L4).
o Is considered as intrathecal contrast injection with
L- puncture needle.
o We have 2 windows
o Soft tissue & bone window.
What are the structures I should evaluate in CT of
• Lumbar spinal canal diameter normally 13 mm.
• Disc lesions.
• facet, sacroiliac joints & paravertebral soft tissue.
8. Soft &bone window (CT) LumbarSoft &bone window (CT) Lumbar
Spinal canal is bony structure, so we see it in
The spinal canal must be closed (at the level of
We measure the AP diameter.
Types of canal stenosis:
11-12 mm & this doesn’t need operation but it
needs operation if there’s disc.
8 -10 mm & it must be operated.
We detect it in soft tissue window.
Posterior border of the disc is more
important as it has relation to the disc.
The normal posterior border of the
disc is CONCAVE.
The abnormal is STRAIGHT OR CONVEX.
. 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
. 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.
15. Normal CT Lumbar
16. Disc bulge(CT axial)
(Spondylosis in spine and osteoarthritis of
1. Osteophytic lipping.
2. Narrow joint space.
3. Subarticular bone sclerosis
4. Sub cortical pseudo cystic changes.
5. Intra articular air.(vaccum phenomena)
19. Vacuum phenomena
20. CT of cervical spine
• Neurocentral joint:
Is the articulation between one vertebra above &
one vertebra below which makes the shape of the
body of the vertebral end plate .
• Facet joint:
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.
Arthritis of the neurocentral or facet joint gives the
same manifestations of nerve compression due to
• We see it in soft tissue window
.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.
. All posterior edges of cervical spine are normally
. See if there’s disc substance protruded than the
. Normal spinal cord picture is kidney shaped.
23. Difference between cervical & lumbar spine in CTDifference between cervical & lumbar spine in CT
No diameters, but
assessed by vision
the spinal cord is
kidney shaped &
surrounded by C.S.F.
Posterior edge of
Is usually convex
All lumbar discs are
concave except L5-S1
is normally convex or
28. CT of the spine
29. CT axial bone& soft tissue widowCT axial bone& soft tissue widow
31. CT machine
38. MRI CT plain x-Ray
C2-3 INTERVERTEBRAL DISC
ARCH OF C-1
BASE OF SKULL
C- 3 SECTION
C-2 SPINOUS PROCESS
44. CT axial CT sagittal
46. Posterior arch #(CT)
47. Burst # (CT) axial
48. sagittal CT
49. CT axial section (base of the skull)
51. CT of cervical spine(sagittal)
52. CT axial
53. CT of cervical spine (axial)
54. CT sagittal
55. CT sagittal tear drop # dislocationTear drop # dislocation(plain)