Radiologic clinics of North America
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Infectious and inflammatory processes of the spinal column are discussed, including disc space infection, osteomyelitis, epidural abscess, arachnoiditis, and rheumatoid arthritis. The relative sensitivity and specificity of various imaging modalities, as well as the imaging characteristics and utility of these various modalities are given. Emphasis is placed on the use of magnetic resonance imaging.
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Spinal trauma is classified according to the mechanism of injury and the presence or absence of stability. A variety of imaging modalities, including radiography, conventional tomography, computed tomography, and magnetic resonance imaging are available for assessment of the injured spine. This article discusses the role of these various methods in evaluating osseous, ligamentous, and neural damage. Common injuries are described at the upper and lower cervical, thoracic, and thoracolumbar regions.
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In recent years MR has been the major advancement in the imaging of lumbar disc disease. Its advantages include multiplanar imaging, excellent resolution, and absence of ionizing radiation. Although CT remains an efficient and accurate method of evaluating the spine, we currently recommend MR imaging as the best initial examination. Myelography with follow-up CT scans should be reserved for specific patients in whom additional information is needed after MR images or CT scans.
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Disc herniation and stenosis in the thoracic spine are relatively uncommon compared with their occurrence in the cervical or lumbar spine. They are usually degenerative, although trauma may be an aggravating or initiating factor. The clinical presentation includes local and/or radicular pain with or without signs and symptoms of cord dysfunction. ⋯ MR imaging is the best way to define the specific abnormality as well as the effect on the adjacent spinal cord. CT after myelography may be useful as well, especially in those patients in whom there is involvement of the posterior ligamentous and osseous structures of the thoracic spinal canal. MR imaging may finally reveal the true incidence of thoracic disc herniation.
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This article deals with the detailed anatomy of the spine most pertinent to magnetic resonance (MR) imaging. The cervical and lumbar regions, the pediatric spine, and the intervertebral discs are emphasized. High resolution MR images of cadaver spines obtained from a 1.5 tesla imager were compared with cryomicrotome sections. This correlative study provided meaningful anatomic information for accurately interpreting and better understanding MR images of living patients.