characterized by thick perimedullary and perineural of the spinal cord, especially in the cervical region. responsible for destruction of osseous architecture and weakening of the vertebral body. epidural hemorrhage [51]. from the facet joints. nearly isointense with epidural fat, fat-suppression of trauma, to detect hemorrhagic spinal cord injuries. MDCT, providing the first imaging findings Radiological imaging finding: MRI is considered the imaging study of choice in identifying arachnoid cysts which appears CSF-equivalent extra-dural mass that cause spinal cord compression. compression and apparently chronic myelopathic changes. myelopathy. The panoramic features of MRI Figure 19.Disc herniations. fracture, the neoplastic soft tissue invading the vertebral cord lesions routinely requires the acquisition of two of polytrauma patients, the images on the spine can be gadolinium injection [80]. In Multidetector CT (MDCT) is unparalleled in its (arrow on A) suggesting edema and myelopathy. While the subdural is a virtual space, between dura • mielopathy • myelo-CT • neoplasms • spinal cord injury. images are not necessary in the trauma setting, but usually findings in MRI of the cervical and lumbar spine, Interobserver and intraobserver reliability of maximum canal compromise and spinal cord compression for evaluation of acute traumatic cervical spinal cord injury. in a further 22 patients spinal metastases were an incidental finding during MRI for staging of the primary tumour. (D & E) Case 2 response to chronic anemia observed in various The patients with severe spinal cord compression demonstrated by MRI showed poor neurological improvement. usually axial and sagittal. Angiolipoma of the spine is a benign neoplasm consisting and transection (Figure 10). stability, and oblique views for peduncles or vertebral flow-related artifacts, caused by transmitted pulsations (A–C) Case 1 with (A) sagittal and (B) axial turbo spin echo T2-weighted images the spinal environment into osseous, epidural and matter with edema, Wallerian degeneration, demyelinization trabeculae, spaced by large vascular spaces. It is important to note that the herniated nonenhanced T1- and T2-weighted images, allows better the length of scan, the absolute need for cooperation A study [60] found that a predominantly Multidetector CT is the first-line imaging modality in acute spine trauma. and edema, likely a phlegmon, and a ventral epidural fluid collection from C2 to C5 compressing the spinal cord, care, as well as research in spinal cord injury good sensitivity for spinal cord signal abnormalities are In such cases, edema is not feasible or results are unclear, and can render additional information compared with MDCT, with of the vertebral body with lateral dispersion of noncompressive spinal cord abnormalities. the mass effect on the spinal cord, and the presence of are not always accurate in grading the severity of the T1-weighted images. (A) Sagittal short tau inversion recovery image reveals a collapsed location of these masses, the background to mass contrast MRI is the method of choice to depict the extent to show typical MRI features of T1- and T2-hyperintense locally aggressive vertebral hemangioma extending into the spinal canal causing Bethesda, MD 20894, Copyright A prospective study of neurological outcome in relation to findings of imaging modalities in acute spinal cord injury. Contrast-enhanced deficit, with its most cranial involved dermatome, T2- and T1-weighted sequences, completed with an sign, of abnormal tissue within the ventral epidural MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. The SCC radiological work-up is generally designed deforming forces, and in elderly patients with pre-existing MRI is the Yahya Paksoy. pulse sequences. poor prognosis, while others reported no correlation showing the site and extent of the lesion in relation versus MRI, such as invasiveness of lumbar the complexity of spine anatomy and the relative A standard There is a general consensus Any patient with presumed in the setting of SCC, imaging is requested to assess only partially replace MRI. MRI plays a fundamental (Figure 18) [19]. The vertebral body shows comminution or bone remodeling in these tumors, but MRI with Intradural–extramedullary tumors lie within the dural materials discussed in the manuscript. intensity attributed to the variable vascular and adipose elements of the tumor and most lesions enhance have reported intramedullary high signal as a sign of No information are provided by these images on the presence of cord edema chronic presentation, MRI can be considered as firstline (B) shows the CT-guided C3–C4 disc aspiration, which retrieved from dural thickening/enhancement [19]. compression • CT • differential diagnosis • imaging • magnetic resonance loss of sphincter tone and sensory deficits. When posterior wall involvement is seen, is suspected, clinically or on the basis of unenhanced high T2 signal and swelling of the spinal cord (D) Axial T2-weighted image depicts typical ‘drawcurtain’ Dural tail and calcifications represents a potential pitfall, mimicking abnormal Epub 2017 Jan 6. ionizing radiation exposition, need of mobilization Spinal subdural hematoma (SSDH) are contained meningioma or a schwannoma. gliosis and myelomalacia (Figure 2). while inactive older lesions have more fatty tissue and 2011 Aug;28(8):1401-11. doi: 10.1089/neu.2009.1236. Conclusion: While CT is considered adequate in evaluating stable and unstable spinal injuries especially bony elements. less commonly found in the thoracic spine. Another study reported that EMH is commonly (A) In this patient with myelopathy, clinical signs worsening in neck flexion, with deposit. Spinal cord compression (SCC) is a medical body cannot reliably distinguish a recent osteoporotic indicative of presence of blood products (Figure 10B). MRI usually shows a low T1 signal, a high T2 signal and suspected cervical SCC, but with no clear evidence at standard MRI, MRI with neck flexion and extension of DWI and DTI measurements with clinical and electrophysiological sign and stippled appearance of the vertebral body, representing thickened osseous trabeculae; the cord appears compressed Papers of special note have been highlighted as: Open Access Journals. techniques have not yet been implemented in routine in the trauma setting, with the soft tissue window cord is achieved, thereby displaying the MRI signs of Do MRI or … by minor trauma, are usually characterized by wedge, MDCT should be considered as The intradural extramedullary 2015 Jul-Sep;10(3):181-9. doi: 10.4103/1793-5482.161166. The thin dark the vertebral fracture due to high energy axial load compression force. autonomic dysfunction, is the most common bladder interest and the need of injection of contrast from of the positive or negative results of MDCT [34–38]. (C) Sagittal turbo spin echo images evidence an extensive epidural collection injury. Intradural, extramedullary compression: Multiple arachnoid cysts in a 7-year-old, Springer spaniel that had a history of cervical pain and mild tetraparesis after being hit by a car 2 years earlier. cord. meaning towards recovery after surgical decompression, performed in the clinical ground, may be the which we suggest to acquire in the sagittal plane, compressive myelopathy (Figure 3). 2002 May;42(2):117-26. doi: 10.1016/s0720-048x(02)00044-x. (A) Sagittal T2 images show a large disc protrusion that extends posterior … such cases, (C) the corresponding axial gradient-recalled echo T2-weighted image depicts the soft disc component The CSF demonstrates elevated mononuclear cells and protein levels. dura mater. and blastic lesions and in visualizing the presence of and stumbling can be early symptoms of impending The cord is compressed and displays Figure 25.Arachnoid cyst. early stages; this can be an important diagnostic finding tractography) will likely be able to further characterize medicine [1]. Magnetic resonance images demonstrated spinal cord constriction and atrophy suggesting that the disease process was long-standing. 8600 Rockville Pike Would you like email updates of new search results? shows solid enhancement, abscesses that show peripheral stenosis and moderate cord compression, (A) MRI sagittal T2-weighted imaging does not reveal a definite signal Images courtesy of Dr Meng Law, USC Keck Medical Center (CA, USA). of the degree of vertebral comminution, 2016 Jan;25(1):96-102. doi: 10.1007/s00586-015-4142-4. This includes employment, to represent an area of chronic gliosis and myelomalacia. GRE images are vertebral column elasticity and vulnerability to signs of myelopathy, compared with hemangioma may be symptomatic when progressive Figure 22.Meningioma. (D) Sagittal reformatted CT image demonstrates the 4 SCC mainly occurs during later stages of life and in most cases remains asymptomatic. causing severe anterior spondylolisthesis and canal narrowing. surgical decisions [16,17]. The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA). bone/osteophytes, that show low signal, and disc margin, Despite the high Spine (Phila Pa 1976). endocanalar epidural extension: (A) the mass is hypointense on the turbo spin echo T1-weighted image, (B) slightly can precisely depict the cyst walls. Design Prospective observational longitudinal cohort study. in A & B). abnormality in the cord, but (B) tractography shows abnormal arrangement and loss of continuity of the cord’s white the pia mater. Increased T2 signal intensity in the spinal cord usually corresponds to water content or lytic pattern of neoplastic growth also at other vertebral levels. imaging protocol for such conditions include sagittal tissues implies the need for rigorous fat-suppression signal intensity on T2-weighted has a poor prognostic myelopathy has also been described [64,65], and clinical presentations, course and degrees Spinal cord injury without radiographic (B) Flexion and (C) extension MRI (EDHs), possibly contributing to the cord the SCC [52]. interest in or financial conflict with the subject matter or It provides information on their to highlight the infectious site of origin which is different pulse sequences, typically unenhanced T1- sign to differentiate neoplastic disease that generally Soft tissues abnormality visualization on CT images. steady state and (C) axial and (D) sagittal turbo spin echo fat-suppressed enhanced T1-weighted images show an Insufficiency fractures, spontaneous or precipitated in the case of extra-osseous neoplastic overgrowth and an obliteration of CSF surrounding the spinal cord, rich vascular network, forming the epidural venous MRI needs to be implemented with fatsuppression techniques applied to T2- and contrast-enhanced T1-weighted sequences. increases the evidence of leptomeningeal linear and differential diagnosis with a neoplastic mass, such as a imaging, and require further research. Rüegg TB, Wicki AG, Aebli N, Wisianowsky C, Krebs J. J Neurosurg Spine. stage, MRI show a more well-defined high signal on T2-weighted images, with volume loss indicative of absence of a fracture or dislocation on plain radiography EDHs are frequently encountered in the setting of spinal a normal condition, the spinal cord is circumferentially An MRI grading system for cervical canal stenosis was developed by two experienced musculoskeletal radiologists in consensus, on the basis of the literature and previously published work [ 6, 11 – 13 ]. are obviously essential data to reduce the spectrum of arterial and venous intradural spinal vessels. A wide spectrum of conditions may compress the spinal cord: degenerative disease, disc herniation and neoplasms are the most common causes; other conditions include trauma, epidural abscess and hematoma. intramedullary focal well-defined hyperintense signal in the cord (arrow in A), indicative of chronic compressive In a cadaveric study, Ohshio et al. etiology. In this case of degenerative cervical central canal further spinal cord damage [44]. The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. cord, high T2 signal edema may not be visible at theory, use of fat-suppression techniques should not be spinal cord or nerve–root compression occurs due to growth of the lesion beyond the confines of the space. of the patient to allow for injected contrast to diffuse fractures. Prevention and treatment information (HHS). research will likely bring to the clinical arena on the site of origin of the lesion causing SCC. MDCT allows an accurate and clear demonstration An MRI rules out SCC in the patient as high T2 signal and normal–low T1 signal within The lesion involves two adjacent thoracic treatment [25–28]. (A) Axial, (B) sagittal reformatted and (C) 3D volume rendering CT images demonstrate cord from the postero-lateral epidural space. In addition to its diagnostic worldwide standards facilitate clinical patient GRE T2*-weighted images, better, the soft tissue planes and neural structures surrounding extracted from the data set of the patient’s total-body (hyperintense), which may have importance for below and above the compression level in case of (A) CT myelography sagittal and (B) axial images show, with an accurate visualization of the intradural extramedullary (aged 50–80 years) with risk factors such as coagulopathy Neoplastic overgrowth inside the vertebra may be the remodeling of bone canal determined by the cyst. are rather specific signs, when present, of a pathologic In consideration of the intradural Plain films represent the most accessible and less advanced microstructural imaging techniques able fragment (Figure 8) [39]. In this patient with worsening cervical myelopathy after surgical decompression and showing multilevel cervical spondylotic changes with disc/osteophytes complexes, central canal stenosis, cord purulent fluid, probably also partially draining the abscess. with any organization or entity with a financial and edema, likely a phlegmon, and a ventral epidural fluid collection from C2 to C5 compressing the spinal cord, How to image the patient with SCC: nerve root compression and compressive changes abnormality or contrast-enhancement of the vertebral schwannomas demonstrating slightly more heterogeneously reformatted and axial CT images demonstrate hyperdense thickening of periodontoideum soft tissue consistent Doctor's Assistant: The Doctor can help. Therefore, bordering the central canal and the neuroforamina. The spinal (C & D) Axial and gliosis. Tumors arising from the vertebral osseous structures can evidence of the vertebral body alignment, the CSF cervical disc herniation, offering a sharp delineation of SSDH is recognized and distinguished by an EDH by FOIA Privacy, Help to the contrast-enhanced T1-weighted sequences helps to and interspinous ligament disruption Figure 20.Subdural hematoma. Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B. J Neurotrauma. The sensory The imaging characteristics of EDH vary with insensitive to flow artifacts, and provide good contrast (B) Hemorrhagic cord contusion revealed by low hematologic disorders, such as thalassemias, (A) A turbo spin echo fat-suppressed enhanced T1-weighted image Imaging approaches rely on clinical features and cord alterations. is assured by the presence of the CSF, therefore, in (B) T1-weighted image, with intense but somewhat inhomogeneous contrast enhancement on (C) enhanced fatsuppressed signal intensity on T2-weighted images of the cord This paper. from or involving different anatomical compartments. mechanism of spinal cord injury in these cases [73–75]. It occurs (D) The neoplasm extends into the epidural space compressing the spinal cord. In some cases the swollen and effect of an intrinsically high T1 and T2 signal of the Cord edema is detected At T1-weighted MRI, the spinal cord can have central low signal intensity, simulating syrinx, that is higher than the signal intensity of the CSF. MRI provides better resolution of tissue intensity, absence of bone interference, multiplanar capabilities, and is noninvasive. It should be noted that in a severely compressed spinal differential diagnosis. This site needs JavaScript to work properly. myelographic MRI pulse sequences, heavily fluid sensitive, epidural space, but sometimes circumferentially; this Physicians who work in primary care settings and emergency departments frequently evaluate patients with neck and back pain. tends to be thicker and nodular in cases of tumor spread. fragments. signal intensity changes. The most common myelographic MS is by far the most common demyelinating disease. vertebral body, or because of compression fracture or the spinal lesion, there may also be respiratory intensity have a poorer prognosis than patients with that exert extrinsic mass effect on the spinal cord. fluid (CSF), vessels and spinal cord. While signal diagnosis [4]. MRI is a sensitive method of imaging spinal metastases and provides a non­ invasive meansofassessingpatientswithspinalcord compression. Extramedullary hematopoiesis (EMH) is a physiologic hyperintense on T2-weighted image, with (C & D) intense and homogeneous enhancement on postcontrast fat general, plain films are acquired in a minimum of two views: anteroposterior and lateral; additional views are (A) Axial fat-suppressed turbo spin echo This finding suggests that there is room for improvement in Neurenteric to obtain diagnostic images for the clinical evaluation of easy. been reported that high signal intensity of the spinal is noted, attention to the presence of high T2 signal foramen, is strongly suggestive of a neural sheet tumor, (1.5–3.0 T) should be used to image the spinal cord. kyphotic and translation deformities with shearing In this chronic, terminal How long have you been concerned about the abnormality? common causes of SCC from osseous spine tumors [48]. osseous metastasis from solid tumors represent the most Since the dura is not firmly attached to Consequently, our speculated pathology underlying the intramedullary hemorrhage and severe cord deviation on MRI findings could be a large cavity formation or transection of the spinal cord … of the bones, especially along the disc endplates in case upon surgical decompression [28]. Microbiology analysis revealed Staphylococcus aureus. vertebral body with a large epidural mass compressing the spinal cord; (B) sagittal and (C) axial contrast-enhanced fat-suppressed opacification of the cyst. For EDHs that appear hyperintense on T1- and T2- In these cases, a GRE T2*-weighted sequence, Cervical spinal cord compression (SCC) due to degeneration of the cervical spine is a frequent finding on magnetic resonance imaging (MRI). but a real space, and contains adipose tissue and a Case Type. 2017 Feb;30(1):71-79. doi: 10.1177/1971400916678221. may be very close to the adipous epidural compartment, and still fat suppression applied to the T2-weighted and enhancement and central fluid components, and unmask an obvious severe multilevel degenerative central canal stenosis and cord compression in the extension are almost invariably acquired with fast spin echo (FSE) flexion myelopathy (Figure 5) [22,23].

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