What are the indications for MRI & CT

1. What are the indications for MRI & CT:  

What are the indications for MRI & CT:
Disc lesions
Post-operative spine(after surgery)
Tumors
Any degenerative disease
Trauma
Congenital abnormalities of the spine

2.

• Preparations for CT & MRI:
1-Fasting for 4-6 hours
2-Contrast material Urographin ,telebrix 1-2
mg/kg
• Administration of contrast:
Yes: In post-operative lumbar spine,
inflammatory disorders& neoplastic lesions.
No: disc lesions, trauma.
Anesthesia
Used with children & uncooperative patients.

3.

Patient position:
Is usually supine, sometimes side lying, &
rarely prone.
How to see:
Scanogram: primitive picture to detect the
site of lumbar spine

4.

Computed tomography (CT):
. Usual scanning.
. Axial slides 2-4 mm.
2 mm in cervical spine / 4 mm in lumbar spine
Has bone & soft tissue window.
CT screening:
. 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
disc lesions.
N.B:
If I want to see one vertebra e.g. L3 I have to take 1
vertebra above (L2 )& 1 below (L4).

5.

6.

7.

CT Myelography:
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 spine:
• Lumbar spinal canal diameter normally 13 mm.
• Disc lesions.
• Others.
• facet, sacroiliac joints & paravertebral soft tissue.

8. Soft &bone window (CT) Lumbar

Soft &bone window (CT) Lumbar

9.

10.

1. Lumbar spinal canal diameter:
Spinal canal is bony structure, so we see it in
bone window.
The spinal canal must be closed (at the level of
pedicles).
We measure the AP diameter.
Types of canal stenosis:
1-Relative:
11-12 mm & this doesn’t need operation but it
needs operation if there’s disc.
2- Absolute:
8 -10 mm & it must be operated.

11.

• Disc lesions:
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.

12.

N.B:
. 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
ABNORMAL.
. 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.

13.

14.

15. Normal CT Lumbar

16. Disc bulge(CT axial)

17.

MRI – LUMBAR SPINEM
NERVE ROOTS
FORAMEN
AXIAL VIEW

18.

Manifestations of arthritis in any joint:
(Spondylosis in spine and osteoarthritis of
other joints)
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

21.

We have 2 types of joints:
• 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
disc lesion.

22.

Cervical disc in CT:
• 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
convex.
. See if there’s disc substance protruded than the
bone.
. Normal spinal cord picture is kidney shaped.

23. Difference between cervical & lumbar spine in CT  

Difference between cervical & lumbar spine in CT
Item
Cervical
Lumbar
Slide Width
2 mm
4mm
Neurocentral joint
Present
Absent
Spinal canal
diameter
No diameters, but
assessed by vision
the spinal cord is
kidney shaped &
surrounded by C.S.F.
13 mm
Posterior edge of
disc
Is usually convex
All lumbar discs are
concave except L5-S1
is normally convex or
flat.

24.

25.

26.

27.

Stages of disc pathology (4 stages)

28. CT of the spine

29. CT axial bone& soft tissue widow

CT axial bone& soft tissue widow

30.

31. CT machine

32.

33.

34.

35.

36.

37.

38. MRI CT plain x-Ray

39.

CT– CERVICAL SPINE
C2-3 INTERVERTEBRAL DISC
FORAMEN
DISC
FORAMEN
FACET JOINT
FACET JOINT
SPINOUS PROCESS
AXIAL
SAGITTAL

40.

CT- CERVICAL SPINE
C-1 SECTION
ARCH OF C-1
DENS
BASE OF SKULL
MASTOID
AXIAL
SAGITTAL

41.

CT- LUMBAR SPINE
POST MYELOGRAM
DISC
SPINOUS
PROCESS

42.

CT– CERVICAL SPINE
C- 3 SECTION
PEDICLE
PEDICLE
LAMIN
A
AXIAL
SAGITTAL

43.

CT-- CERVICAL SPINE
C-2 SECTION
C-2 BODY
DEGENERATE
D
C6-7
C-2 SPINOUS PROCESS
AXIAL
SAGITTAL

44. CT axial CT sagittal

45.

CT- LUMBAR SPINE
POST MYELOGRAM
Axial
PEDICLE
PEDICLE
NERVE ROOTS

46. Posterior arch #(CT)

47. Burst # (CT) axial

48. sagittal CT

49. CT axial section (base of the skull)

50.

CT- LUMBAR SPINE
POST MYELOGRAM
FORAMEN
FORAMEN

51. CT of cervical spine(sagittal)

52. CT axial

53. CT of cervical spine (axial)

54. CT sagittal

55. CT sagittal tear drop # dislocation

Tear drop # dislocation(plain)

56.

CT-LUMBAR SPINE
POST MYELOGRAM
THECAL SAC
LAMINA
LAMINA

57.

CT- LUMBAR SPINE
POST MYELOGRAM
FACET JOINTS

58.

CT- LUMBAR SPINE
POST MYELOGRAM
PEDICLE
PEDICLE
NERVE ROOTS