MRI Spine

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Lecture

• MRI Spine

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Bone marrow changes

• 1- Type I edema
• 2- Type II fatty ( white in T1)
• 3- Type III bone sclerosis (like bone cortex
  black in T1 T2)
• Degenerative marrow changes
• If bony end plate is white in T1 ? fatty as it
  's not seen in T2
• If bony end plate is black ? sclerosis

3

•  
•  
• 1- Hypertrophy (developmental spinal canal
  stenosis)
• 2- calcification
• 3- ossification 
•  
•  
• .Calcium deposition is more seen in CT than in
  MRI as ca is black in both T1T2
• . Buckled ligamentum flava I see if spinal
  canal is encroached or no.
• . Ossification of posterior longitudinal
  ligament OPL
•  
• N.B
• Osteophytes has wide base against vertebra versus
  ossification has narrow base

4

• 1- edema due to compression by disc (ant)
  ligamentum flava (post)
• 2- early myelomalacia reversible if edema is
  treated
• 3- late myelomalacia irreversible if edema
  isn't treated
• N.B.
• Both early late myelomalacia produce focal area
  (white stain) of low signal in T1 high signal
  in T2 so we differentiate by clinical pressure,
  by history duration of illness
• If it's recent ?edema
• Not so far? early myelomalacia
• Far ? late myelomalacia
• If there is local lesion in spinal cord without
  compression? another pathology
•  

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Paravertebral soft tissue shadows

• .Hemorrhage, bone fragments
• . Abcesses( inflammatory disorders)
• .Tumor (neoplastic extra osseous mass)

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Contrast administration DTPA

• We use it to differentiate between postoperative
  scar tissue residual or recurrent disc lesions
• If it gains dye (becomes white in colour) ? scar
  tissue
• If it doesn't gain dye ? disc lesion
• If part gains dye part doesn't gain ? so
  there's both disc scar tissue

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Indications of contrast

• 1- To detect site of operation
• 2- To detect degree of thecal decompression
• 3- To detect post operative complications

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• Post operative cervical surgery
• There's no contrast administration in cervical
  spine as the aggressiveness of scar tissue
  formation in cervical spine is not as in lumbar
  spine after surgical interference.
• N.B.
• Contrast administration from 2 month to 20 years
  not after that as scar tissue becomes mature
  contrast doesn't appear.

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Types of surgery

• 1- spinolaminectomy
• 2-hemi laminectomy
• (pore in the lamina suction of the disc)
• 3-laminar fenestration minimally invasive ( the
  lamina of the above vertebra which is removed)

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Post operative complications

• 1- Scar tissue / disc lesions (scar tissue
  enhances)
• 2- Disc space infection
• 3- Arachnoiditis (adhesion between cauda equina
  nerve roots)
• N.B.
• Perineural scar scar formation around roots
  which become compressed
•  

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• Differential diagnosis between nerve root
  recurrent disc
• After contrast administration if we see a black
  point on one side look at the contra lateral side
• if there's also another black point so this is a
  nerve root
• if there's not present so this is recurrent
  disc
• N.B.
• Usually the nerve root at site of scar tissue is
  thick due to compression which leads to swelling

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• Arachnoiditis
• It's diagnosed in axial T2 image never to be
  diagnosed in sagittal image
• As nerve roots are black C.S.F. is white
• Pseudo cord sign
• All nerve roots become adhesive to each other
  appear as a cord in the cauda equine level (after
  L1-L2)
• Empty thecal sac sign
• Nerve roots become attached at the edges of the
  thecal sac
• Disc space infection
• Hyperemia, fluid, pus,
• edges of the vertebrae are filled with water? In
  T2 appears white in T1 appears black

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Comparison between degenerated disc and disc
space infection
Degenerated disc Disc space infection
. Disc is black in T1 T2 . Presence of osteophytes with bone marrow changes. disc is white in T2 but black in T1 . sclerotic only
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