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Bones

Generalized increased bone density in an adult Most common 1. Metastases —prostate and breast most common. Heterogeneous; generally not diffuse. 2. Sickle cell disease —medullary sclerosis and bone infarcts. Growth arrest of long bones. H-shaped vertebrae. 3. Myelofibrosis —older patients. Diffuse medullary sclerosis, loss of corticomedullary differentiation. No heterogeneity. Less common 4. Renal osteodystrophy —axial > appendicular. Rugger jersey spine. 5. Osteopetrosis —thickened cortices with reduced…

Future Trends in Spinal Imaging

Introduction Imaging methods of the spine have greatly expanded since the advent of X-rays for the use of plain radiographs (c.1895), providing anatomical clarity for diagnosis and treatment of the cervical, thoracic, lumbar, and sacral vertebrae. The complex anatomy of the vertebrae and irregular contours and geometry of the spinal elements have influenced the rapid development of more precise imaging modalities. Various advancements to two- and…

Clinical Correlations to Specific Phenotypes and Measurements With Classification Systems: Lumbosacral Spine

Introduction Over the past few decades, the management of lumbosacral spinal disease has become notoriously difficult, whereby complex biomechanics and heterogeneity in presenting conditions have challenged treating clinicians. In response, classification systems emerged, leading to expanded characterization of disease and improvements in treatment guidelines. Though the earliest classifications of the lumbosacral region were simply descriptive, advances in knowledge and technology have since led to systems resulting…

Lumbosacral CT

Lumbosacral Anatomy Osseous Anatomy The lumbosacral spine consists of five lumbar (L1–L5) and five sacral vertebrae (S1–S5) and their associated intervertebral discs, nerves, muscles, ligaments, and blood vessels. Each vertebra consists of a vertebral body, vertebral arch, and seven processes. The vertebral bodies are responsible for absorbing most of the axial forces exerted on the vertebrae. The vertebral arches and the dorsal part of the vertebral…

Lumbosacral Spine MRI

Introduction The lumbosacral spine consists on average of 5 lumbar vertebrae, the sacrum, and coccyx. An MRI scan of this area is used to accurately depict soft tissue in and around the lumbosacral spine. Measurements mainly focus on a change in signal intensities and less on absolute distances or angles. Various pathologies affect the configuration of the soft tissue, which can lead to clinical symptoms such…

Lumbosacral Spine Plain Radiographs

Introduction The lumbosacral spine consists of five large vertebrae that make up the lumbar spine and five fused vertebrae that make up one single bone which articulate on each side of pelvis called the sacrum. Overall, spinal balance is determined by a mixture of kyphosis and lordosis throughout the spine. Lumbar lordosis is an important factor in overall sagittal balance, which contributes to bipedalism posture and…

Full-Length Spine—Clinical Correlations With Specific Phenotypes and Measurements With Classification Systems

Introduction Full-length radiographic spinal imaging is indicated in several clinical scenarios such as screening for congenital abnormalities of the spine, demyelinating processes affecting the spinal cord, scoliosis diagnoses, and trauma as well as many other clinical indications. Abnormalities that arise in early embryologic osseous and neurologic development may foresee the development of spinal deformities. Spinal imaging typically begins with a series of full-length radiographs, including AP,…

Full-Length Spine CT and MRI in Daily Practice

Conflicts of Interest The authors declare no conflicts of interest regarding the publication of this paper. Introduction There are multiple imaging modalities to evaluate the spine. The type of imaging tool for the spine depends on the type of disease, the amount of radiation hazard, as well as contraindications and any allergy to contrast. Among the multiple imaging strategies, computed tomography (CT) is a reliable method…

Full-Length Spine—Plain Radiographs

Introduction The evaluation of spinal pathologies is dependent upon careful history, clinical examination, and appropriate full-length spine radiographs. Appropriate full-length spine radiographs should be obtained when evaluating a patient for suspected coronal, sagittal, or combined imbalance. Full-length spine should ideally include C7 and both femoral heads. This ensures that important landmarks used for parameter calculations are readily available. Plain radiographs can be obtained either through a…

Clinical Correlations to Specific Phenotypes and Measurements With Classification Systems

Introduction Classification systems provide a common language through which physicians and researchers can communicate. They can help create a framework for standardized treatment algorithms through which surgeons can directly and reproducibly contribute to improvements in patient outcomes. In order for these algorithms to be generalized to the population, they must be clinically relevant, reliable, and validated. If measurements are involved as part of the tool for…

Subaxial Cervical Spine CT

Introduction Computed tomography (CT) scans have become the mainstay modality for screening patients in the setting of cervical trauma and identifying fractures in the subaxial cervical spine. High-resolution CT imaging, in particular, has become the primary radiologic means for screening patients at most trauma centers, largely replacing radiographs given a superior sensitivity (90%–100%) in identifying traumatic bony injuries. It is therefore critical for spine surgeons and…

Magnetic Resonance Imaging Techniques for the Evaluation of the Subaxial Cervical Spine

Introduction The advancement of magnetic resonance imaging (MRI) has made high-quality visualization of the normal and pathologic spine, as well as associated neural tissue, readily available. Relative to plain radiography and computed tomography (CT), MRI boasts excellent visualization of soft tissues without exposing the patient to harmful radiation. Within the cervical spine specifically, MRI is routinely used for evaluation of neck pain and radicular symptoms. Several…

Subaxial Cervical Spine Plain Radiographs

Introduction The subaxial cervical spine refers to cervical vertebrae located below the “axis” (C2) and is a critical distinction due to inherent biomechanical differences from vertebral levels more cephalad and caudad. Responsible for the majority of cervical range of motion, vertebrae ranging from C3 to C7 contribute roughly 70 of flexion, 40 of extension, 30 of lateral bending, and 45 of rotation to either side. Furthermore,…

Clinical Correlations to Specific Phenotypes and Measurements With Classification Systems

Source of Funding The authors received no outside funding for the work presented in this chapter. Conflict of Interest The authors have no conflicts of interest related to the subject matter presented in this chapter. Introduction Trauma to the upper cervical spine can result in a spectrum of pathology, ranging from benign to catastrophic. Upper cervical spine fractures account for nearly 70% of all cervical injuries…

Upper Cervical Spine: Computed Tomography

Introduction The craniovertebral junction is designed to be strong in order to maintain the head on the shoulders. This junction is also supple and mobile to allow for looking at the world in all directions. While mobility and stability are the hallmarks, the architecture is immaculately tuned to provide a wide space for free traversing of critical neural and vascular structures. A large complex of ligaments…

Upper Cervical Spine MRI

Introduction Magnetic resonance imaging (MRI) is an essential modality in evaluating the ligamentous and soft tissue elements of the upper cervical spine. This region has horizontally oriented facets and no intervertebral discs; ligaments and membranes are thus crucial in stabilization at these levels. This makes MRI an invaluable tool in assessing high cervical injury. MRI also demonstrates prevertebral and posterior neck soft tissue edema in such…

Radiographic Evaluation of the Upper Cervical Spine

Introduction The upper cervical spine contains the craniocervical junction (CCJ), the atlas or C1, and the axis or C2. A large proportion of overall cervical motion comes from the upper cervical spine between the CCJ and C2. The CCJ accommodates approximately 45 degrees of flexion extension. This is more than any other single cervical level. The C1–2 joint is responsible for approximately 40 degrees of axial…

Pitfalls

Anatomic variants ◼ Accessory spleen: very common. Typically near spleen. Can be intrapancreatic. Can be mistaken for a mass. Should look like spleen on all imaging sequences. ◼ Duplicated renal collecting system: prone to obstruct Has surgical implications. ◼ Prominent column of Bertin: mimics focal renal mass. Has similar echogenicity, density, and magnetic resonance imaging (MRI) signal intensity to normal renal cortex. ◼ Pancreas divisum: no…

Abdominal/pelvic trauma

Anatomy, embryology, pathophysiology ◼ Injuries depend upon patient composition, blunt versus penetrating injury, mechanism of injury, and strength of forces. ◼ Blunt trauma etiologies: motor vehicle crash, falls, assault, and sports resulting in deceleration/shear forces, crushing forces, and increased intraabdominal pressure. ◼ Major cause of preventable death is intraabdominal hemorrhage. Techniques Radiography ◼ Rapid and portable, facilitating use in the critically ill patient for detection of:…

Postoperative imaging

Techniques Plain radiography Plain radiographs are often used in the postoperative abdomen to evaluate lines and tubes, bowel gas pattern, retained foreign bodies, and the presence of pneumoperitoneum. Fluoroscopy Fluoroscopic upper gastrointestinal (GI) examination with water-soluble or barium enteric contrast can be used to evaluate for leaks in the areas of postoperative change. Depending on the institution, postoperative “leak studies” may be routine following certain procedures…