mri of acute spinal trauma
TRANSCRIPT
![Page 1: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/1.jpg)
MRI of acute spinal trauma
SHIVAPRAKASH.B.H2nd yr RESIDENT
BARNARD INSTITUTE OF RADIOLOGY
![Page 2: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/2.jpg)
To describe various components of spinal injuries on MRI.
To know whether mechanism of injury can be assessed by pattern of injury.
AIM
![Page 3: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/3.jpg)
Anatomy Approach Mechanism of injury
![Page 4: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/4.jpg)
Normal anatomy - Axial
Vertebral body level
![Page 5: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/5.jpg)
Normal anatomy - Axial
Intervertebral disc level
![Page 6: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/6.jpg)
Sagittal
![Page 7: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/7.jpg)
Normal anatomy - Parasagittal
![Page 8: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/8.jpg)
Dennis 3 Column concept
![Page 9: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/9.jpg)
Sections Sequences
Sagittal T1W SE,T2W FSE
Axial T1W SE,T2W FSE
Imaging protocol
Sequences SignificanceFat sat T2W/STIR BONY EDEMA &
INJURY TO INTERSPINOUS LIG
T2W GRE CORD HEMATOMA
![Page 10: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/10.jpg)
Malalignment in sagittal plane, Change in vertebral body contour.
Vertebral injury
To look for It implies
Break in the continuity of the signal void
Vertebral cortex injury
Signal change Haemorrhage and oedema within the vertebral body
![Page 11: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/11.jpg)
Wedge compression injuries
Bands of hyperintensity on T2-weighted images parallel to the end-plate,
Fracture of the superior end-plate,
Buckling of the anterior vertebral body cortex.
D12 wedge compression #
![Page 12: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/12.jpg)
Burst fractures Associated
disruption of the posterior vertebral body cortex.
D12 burst #
![Page 13: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/13.jpg)
Sectional plane To look for
Parasagittal Subluxation and dislocation of the facet joints
Axial images Fractures of the neural arch
C6 – C7 IVD
C7
![Page 14: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/14.jpg)
Anterior longitudinal (ALL), Posterior longitudinal (PLL) and Posterior ligamentous complex (PLC) comprising the ligamentum flavum. (LF), interspinous ligament (ISL),
supraspinous ligament (SSL) and facet joint capsules.
Ligaments of the spine
![Page 15: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/15.jpg)
![Page 16: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/16.jpg)
Rupture Discontinuity of the ligament, Stripping of the intact ligament, Partial avulsion or attenuation of the
ligament and combined osseo-ligamentous injury.
Best identified on T2-weighted images.
Ligament injuries
![Page 17: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/17.jpg)
D11 over D12
D 11 fracture D12 wedge compression #
![Page 18: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/18.jpg)
Intradiscal haemorrhage/oedema, Annular rupture, Avulsion from the end-plate and herniation,
either into the epidural space or into the vertebral body.
Disc injury
![Page 19: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/19.jpg)
D12 #
![Page 20: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/20.jpg)
D11 over D12
![Page 21: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/21.jpg)
Type On T1W On T2W
Type 1 (Intramedullary hematoma)
Depends on age Depends on age
Type 2 (Cord edema)
Diffuse swelling of cord
Diffuse hyperintensity of cord
Type 3 (Mixed lesion)
Small central hypointensity surrounded by flame shaped areas of oedema
Neural injury
![Page 22: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/22.jpg)
Cord hematoma
![Page 23: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/23.jpg)
C5-C6,C7-C8 IVD levels
![Page 24: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/24.jpg)
Cord edema
![Page 25: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/25.jpg)
Transection
C5 over C6
D10 over D11
![Page 26: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/26.jpg)
Focal kyphosis, Abnormal separation of facets/spinous
processes. Evidence of canal compromise and ventral
cord edema.
Hyperflexion injury
![Page 27: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/27.jpg)
C4 over C5
![Page 28: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/28.jpg)
Soft tissue edema in post spinal soft tissue. Edema and disruption of ALL and nuchal
ligament injury.
Hyperextension injuries
C5 over C6
![Page 29: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/29.jpg)
Altered adjacent facetal relationship. Spinous process malalignment. Focal vertebral body kyphosis.
Hyperflexion rotation injury
![Page 30: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/30.jpg)
A perched facet joint, is a vertebral facet joint whose inferior articular process on one side appears to sit 'perched' on the superior articular process of the vertebra below.
Perched facet
![Page 31: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/31.jpg)
Locked facet
![Page 32: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/32.jpg)
Unilateral facet or laminar fracture due to hyperextension with rotation combined causing ligament disruption.
Hyperextension rotation injury
C7
![Page 33: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/33.jpg)
Mimics
![Page 34: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/34.jpg)
![Page 35: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/35.jpg)
MRI is best for assessment of the patient with acute spinal injury.
Careful attention to technique and imaging allows us to complete evaluation of injury to the vertebral column, ligaments, discs and cord.
The array of findings associated with mode of spinal injury allows us conclude about mechanism of injury to spine.
To conclude
![Page 36: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/36.jpg)
Thank you
![Page 37: MRI of Acute Spinal Trauma](https://reader036.vdocuments.site/reader036/viewer/2022081518/552040704979597f2f8b48c2/html5/thumbnails/37.jpg)