Axial Skeleton Radiology

Spine Radiograph indications

Trauma/Fracture, degenerative disc disease (spinal instability), evaluation of primary and secondary malignancies, arthritis, suspected spinal instability, Shoulder or arm pain, Hip or leg pain, Occipital headache, Limitations in motion, Planned or prior surgery, Suspected congenital abnormalities, Syndromes associated with spinal abnormality, Evaluation of spinal abnormality seen on other imaging studies, Follow-up of known abnormality

Canadian C-Spine Rule

What is the following imagining referring to?

X-Ray Interpretations

alignment and Anatomy, disk height (as well as the facets)

Spine CT indications

Acute trauma, Degenerative conditions and osteoarthritis, Bone Density (Osteoporosis), Infectious processes of the spine, “With Contrast”- Intravenous injection to observe blood vessels and vascular tissues, Image guidance for spinal interventions, Neoplastic conditions, Inflammatory lesions, Congenital or developmental spinal abnormalities (ex. Scoliosis), Spinal cord syrinxes or intrathecal masses when MRI is contraindicated, Myelogram- water soluble contrast media into subarachnoid space to observe spinal cord, Post-op evaluation of bone graph or instrument fusion

CT Interpretations

Alignment and Anatomy, Bone Density Canal Space, Disk Integrity, Soft Tissues

What is the difference between a Spine MRI and spine CT

A spine MRI focuses more on soft tissue

Spine MRI indications

Suspected Disc Herniations or Degenerative Disc Disease (radicular symptoms), Extradural soft tissue, Intradural masses/tumors, Post-op soft tissue changes, Intrinsic spinal cord pathology, Bony neoplasm, Spinal vascular malformations, Spinal infections, MRI with contrast- outlines tissue with abnormal vasculature

MRI interpretations

Alignment, Bone Signal, Canal space and central nervous system, Disk integrity (Bulging, Herniation, Protrusion and Extrusion)

What's the view and what can you see in it?

AP open-mouth cervical spine, articulation of C1-C2 ( atlantoaxial joint). fracture of dens

When do you take an AP open-mouth cervical spine radiograph?

after head injuries

What view is this?

vertical column: A-P view. Spinous processes are midline. Lateral column: Lateral view

What view is this? What do you see in it?

lateral cervical spine radiograph.

Anterior borders create lordotic curve. box like vertebral bodes. disk spaces. articular pillars and facet joints

What view is this? What is it useful for?

right posterior oblique cervical spine radiograph.

useful for observing the intervertebral foramen

What is the picture showing? How do you know?

avulsion fracture and ligament rupture. disc height increased in the picture on the right in the lower vertebrae

What is this picture showing? What is the MOI?

Tear Drop fracture. flexion or extension injury

Name the pathology

Degenerative disk disease

What should you note about the dens? and the spinal canal?

position of the dens. diameter of spinal canal. width of spinal canal should equal width of vertebral body

What is the picture showing?

vertebral alignment

What is this picture showing?

dens fracture

What is this picture showing?

Fracture through vertebral body

What view is this?

T1 sagittal MRI at midline

What pathology is this?

Whiplash

What pathology is this?

Disk prolapse with spinal cord compression

Name the pathology

kyphosis and compression fractures in osteoporotic female

What type of fracture is this? When does it occur?

Seatbelt fracture (horizontal split of the vertebrae). When the spine is forcefully flexed forward, often during a MVA

What is this radiograph showing?

multiple rib fractures

What is this radiograph showing?

the cobb angle

Name the pathology

scoliosis

Name the view. What structures can you see in it?

normal PA chest radiograph. Diaphragm at T10 and ribs T1-T10

Number the picture

1. superior vena cava

2. ascending aorta

3. right atrium

4. inferior vena cava

5. left subclavian vein/artery

6. aortic arch

7. pulmonary artery

8. left atrium

9. left ventricle

Name the pathology

pneumothorax (collapsed lung)

Which way does the trachea deviate in a pneumothorax?

the trachea deviates away from the side of the pneumothorax

What position is this?

AP projection

What position is this?

lateral projection

What positions are these? A and B

A. RPO (right posterior oblique)

B. LPO (left posterior oblique)

what joints can we see in these radiographs

L5-S1 and S1 joints

Name the pathology

spondylolysis

Name the pathology

spondylolysis

What is spondylolysis

disruption of pars interarticularis or a scotty dog fracture

what is spondylolisthesis

slippage of superior vertebrae on inferior vertebrae

Name the pathology

spondylolisthesis

Name the pathology

spondylolisthesis

What is spinal stenosis?

Narrowing of the spinal canal

Name the common pathology

spinal stenosis

Name the pathology

disk herniation

Name the pathology

ankylosing spondylitis

What is ankylosing spondylitis?

inflammatory disease of the spine

Name the pathology

Spina bifida occulta

what is spina bifida occulta?

vertebrae do not completely close during fetal development

The main indications for a spine radiograph are

Trauma/fracture, degenerative disc disease, evaluation of primary and secondary malignancies, arthritis

What is the Canadian C spine rule used to determine?

If a radiograph is indicated in a patient with neck pain

Main indications of a spine CT

Acute Trauma, Degenerative conditions and osteoarthritis, bone density (osteoporosis), infectious processes of the spine