Spinal Parlance This chapter begins with a brief review of the anatomy of the spine. Imaging techniques are then discussed, followed by the normal imaging appearance of the spine on magnetic resonance (MR) imaging and computed tomography (CT). We then consider degenerative diseases of the spine. These common diseases may manifest as localized back pain, radiculopathy (pain radiating in a spinal root distribution), or myelopathy (signs…

As opposed to the mucosal diseases of the head and neck, in which the differential diagnosis usually revolves around squamous cell carcinoma 90% of the time, the extramucosal space allows the radiologist to exercise finely honed skills in forming a differential diagnosis. Rumination, differentiation, pontification and “clinical correlation” may follow—and not just in this chapter. The reader should understand that more comprehensive multivolumed dry texts dealing…

The approach to this chapter on mucosal disease is divided along disease categories combining all regions except for the discussion of malignant masses. Because the basis for discussing cancers with clinicians is rooted in the TNM staging of the American Joint Commission on Cancer, which is itself subdivided by anatomic location, the chapter will analyze squamous cell carcinoma based on sites of origin. An old adage…

To appreciate the pathogenesis of sinusitis, you must understand the normal anatomic pathways of mucociliary clearance in the paranasal sinuses ( Fig. 12-1 ). The cilia within the maxillary sinus propel the mucous stream in a starlike pattern from the floor of the maxillary sinus toward the ostium situated superomedially. In approximately 30% of patients, a second accessory ostium to the maxillary sinus is present inferior…

The detailed bony anatomy of the vestibulocochlear structures of the temporal bone makes computed tomography (CT) the primary method of evaluating the erosive and inflammatory lesions of the temporal bone. Magnetic resonance imaging (MRI) also has an important role in the evaluation of temporal bone pathology, particularly when evaluating vascular and neoplastic processes affecting this region. A good understanding of the anatomy of the temporal bone…

Anatomy True story: in order to understand imaging of the skull base you are going to have to appreciate the normal anatomy first. We define the skull base as the region from the upper surface of the ethmoid bone and orbital plate of the frontal bone to the occipital bone. Central to the skull base is the sphenoid bone—the main attraction, so to speak. The bone…

Time to play with the eye-ball—at first base, anatomy. The orbit is a cone-shaped structure made up of seven bones ( Fig. 9-1 ). The roof is formed by the orbital plate of the frontal bone anteriorly and the lesser wing of the sphenoid bone posteriorly. The lateral wall of the orbit is composed of the zygomatic bone anteriorly and the greater wing of the sphenoid…

Timing of Formation of Congenital Lesions If you think your ex utero life is complicated, wait till you see what goes on in utero! Understanding development of the central nervous system (CNS) aids in understanding congenital brain and spine anomalies and coexistence of multiple anomalies. Although there is some overlap, to put things simply, the CNS goes through six major developmental events that include (1) primary…

The debate over whether a patient has atrophy or hydrocephalus has consumed an enormous number of pages in the neuroradiologic literature and whole sessions of national meetings. Why the fuss? Well, the implications as far as prognosis and treatment are vastly different between the two, so accurate distinction is essential! Atrophy reflects the loss of brain tissue, be it cortical, subcortical, or deep. With the loss…

White matter diseases are heterogeneous conditions linked together because they involve the same substrate. Magnetic resonance imaging (MRI) is quite sensitive and, when combined with age and other pertinent clinical information, provides a reasonable amount of specificity for white matter lesions. We are going to start by dividing white matter diseases into demyelinating ( Box 6-1 ) and dysmyelinating diseases ( Box 6-2 ). BOX 6-1…

A plethora of infectious and noninfectious inflammatory diseases affects the central nervous system (CNS). The normal brain responds to these insults in a rather limited, unimaginative, and stereotypical masculine manner. Initially it gets rubor (increased perfusion), calor (hot), tumor (edematous) but without dolor (pain) unless the meninges (surface) are affected. In most cases, there is a concomitant abnormality of the blood-brain barrier with associated enhancement. Later,…

Let’s start off with some depressing statistics. Traumatic brain injury (TBI) has an incidence of over 500,000 cases per year, and is the leading cause of disability and death in children and young adults in the United States. The annual cost of TBI, including direct costs and lost income, is estimated to be above $25 billion. It has a peak incidence in 15- to 24-year-olds with…

Imaging is an essential component in the workup of patients presenting with symptoms of stroke. “Stroke” is a nonspecific clinical term denoting a sudden loss of neurologic function by any cause (e.g., ischemic infarction, spontaneous hemorrhage, post ictal state). A host of new and evolving imaging techniques have been developed in the recent past allowing for ever more accurate and timely detection and characterization of stroke…

The World Health Organization (WHO) classification of tumors of the brain remains the worldwide standard. Members of the International Society of Neuropathology, International Academy of Pathology, and Preuss Foundation for Brain Tumor Research met in Lyon France for several bottles of wine and a lengthy discussion of whether to use “tumor” or “tumour” among other topics. Late at night, over brie and baguettes they subsequently produced…

The anatomy and function of the brain is fascinating and complex, and we are still only scratching the surface in terms of our understanding of these structures. Nevertheless, a basic understanding of structure and function is critical in providing meaningful and accurate reporting of the pathology in the brain. Although we will discuss the development of the brain in Chapter 8 , we will address the…