1. SPINAL CORD Dr. Sajjad Hussain Faculty in Neuroradiology
Department of Radiology and Medical Imaging
King Saud University / King Khalid University Hospital

2. Imaging Methods to Evaluate Spine
Plain X-Ray Films - bones
Myelogram – injection of contrast medium in CSF followed by x-ray images. Rarely performed now-a-days
Computed Tomography (CT Scan)
Magnetic Resonance Imaging (MRI)
Spinal angiography – to evaluate arteries and veins
Ultrasound – more in children
Radionuclide Bone Scan – intravenous injection of radioactive material bound to phosphonates which deposit in bones, followed by images by gamma camera.
DEXA – radionuclide scan for bone density (osteoporosis)

3. X-RAYS (RADIOGRAPHS)
Often the first diagnostic imaging test, quick and cheap
Small dose of radiation to visualize the bony parts of the spine
Can detect
Spinal alignment and curvature
Spinal instability – with flexion and extension views
Congenital (birth) defects of spinal column
Fractures caused by trauma
Moderate osteoporosis (loss of calcium from the bone)
Infections
Tumors
May be taken in different positions (ie; bending forward and backward) to assess for instability

4. COMPUTERIZED TOMOGRAPHY (CT SCAN)
Uses radiation
Obtain 2-D images  can be processed to 3-D images
Patients lies on a table that moves through a scanner
Much detailed information regarding bony structures
Limited information about spinal cord & soft tissues
Entire spine can be imaged within a few minutes

5. CT SCAN

7. Magnetic Resonance Imaging (MRI)
Gold standard of imaging for spinal cord disorders
No radiation
Can identify abnormalities of bone, soft tissues and spinal cord
Patient lies still on a table that moves through a tunnel like structure
Takes about minutes
Claustrophobic patients, uncooperative / semiconscious patients, and children may need sedation or general anesthesia
Contraindications include implanted devices e.g. cardiac pacemakers, electromagnetic devices, certain metal clips and stimulators
Artificial joints and other fixed metals  no problem

8. MRI SCANNER

9. MR images are multi-planar

10. MR images are very high resolution

11. MR images are very high resolution

13. Abnormalities of spinal cord
Congenital
Trauma
Demyelination
Tumors
Ischemia

14. Congenital

15. MR# Lipomyelomeningocele with tethered cord, mistaken for myelomenigocele at birth and partially resected without untethering cord. Now 11 y/o with progressive cavovarus deformity, LE weakness and incontinence.

16. Antenatal US
Antenatal MRI

18. Trauma

20. 24 years old with paraplegia after road traffic accident since 3 years

21. Hyperflexion fx with ligamentous disruption and cord contusion

22. Vertebral Artery Dissection/Occlusion Secondary to C6 Fracture

23. Tumors

25. AJNR

26. Astrocytoma

27. Astrocytoma

28. Ependymoma
Figure 3a.  Ependymoma in a 32-year-old woman with upper- and lower-extremity weakness and numbness and bowel and bladder dysfunction. (a) Contrast-enhanced sagittal T1-weighted MR image demonstrates a heterogeneously enhancing mass expanding the cervical spinal cord. A cyst with faint peripheral enhancement (arrowhead) is seen at the superior pole of the mass. (b) Sagittal T2-weighted MR image reveals that the mass is predominantly isointense relative to the spinal cord, with scattered areas of high signal intensity. There is a curvilinear area of low signal intensity (arrowheads) at the C2-3 level, which is suggestive of hemorrhage. (c) Intraoperative photograph demonstrates the lobulated, irregular mass with areas of hemorrhage (arrows).

30. venous hypertension (e.g. AV fistula)
Cord Edema
As in the brain, may be secondary to ischemia (e.g. embolus to spinal artery) or
venous hypertension (e.g. AV fistula)
Dural AVF
MR#

31. Transverse Myelitis Inflamed cord of uncertain cause Viral infections
Immune reactions
Idiopathic
Myelopathy progressing over hours to weeks
DDX: MS, glioma, infarction

32. Multiple Sclerosis
Inflammatory demyelination eventually leading to gliosis and axonal loss
T2-hyperintense lesion(s) in cord parenchyma
Typically no cord expansion (vs. tumor); chronic lesion may show atrophy

33. Key Points for MS, Transverse myelitis, and ADEM
MS lesions in spinal cord
are more likely multiple, focal and peripherally located
don’t cover the entire section on axial images
often < 2 vertebral body heights on sagittal images
are disseminated in time and space
may enhance in acute phase
Transverse myelitis lesions
extend over >3 vertebral body heights on axial images
often > 4 vertebral body heights on sagittal images
no brain lesions
ADEM and NMO lesions in spinal cord – similar but presence of
Brain lesions  ADEM
Optic nerve lesions  NMO

34. SYRINGOHYDROMYELIA Seen with: congenital lesions Chiari I & II
tethered cord
acquired lesions
trauma
tumors
arachnoiditis
idiopathic

35. SYRINX
On imaging, a syrinx is
a longitudinally oriented CSF-filled cavity with surrounding myelomalacia / gliosis
may have a beaded or cystic expansile configuration