LUBMAR MRI or GENERAL SPINE SEARCH PATTERN:

 

1.  Number the vertebral bodies.

2.  check aligment

3.  check for height loss or fracture

4.  Look for marrow signal abn on T1

5.  Look for marrow signal abn on STIR

6.  Look for ligamentous signal abnormalites on STIR

7.  Look for disc dissecication

8.  Look for cord signal abn/ lesions

9.  Look for conus termination on sag and axial

10.  Look at cauda equina nerve roots for clumping / arachnoiditis

11.  Go level by level

12.  Look at disc for bulging or protrusion, central, paracentral, foraminal, extraformainal

13.  Look for ligamentum flavum hypetrophy, facet arthroapathy

13.  Look for central canal narrowing

14.  Look for neural canal narrowing, use T1 sagital to find plane of neural canal

15.  Give impression worst level

 

 

Re. extensive conversation with LB

 

Cord compression is ambiguous term that at some institutions attending neurorads dont use

 

cord compression is ?clinical diag

 

there is cord deformity which could be acute, usually acuteness is assoc with incerased fluid signal and enlargemetn where as malacia or chronic change assoc with incrased fluid signal and volume / parenchymal loss

 

acute cord deformation vs. nonacute / chronic cord deformation

 

similar covo with AF

 

and cord comperssion reasonable diagnosis to make

 

takl about cord expansion (edema in my mind)

 

takl about myelomalacia (cord weaking kinda like encephalomalcia in the brain)

 

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re. spine tumors loc

 

intramedullary (within spine cord or cauda equina substance)

epdedymoma

astrocytoma

hemangioblastoma

demyelinating plaque

 

within dura, outside of cord substance:

schwanoma

neurofibroma

meningioma

myopapapillary ependymoma

epidermoid / dermoid

 

extradural (outside thecal sac impinging on it)

Herniated disc *** prob most common i've seen

vertebral neoplasm

epidural mets

hemangioma

epidural lipomatosis

Epidural abscess***

 

Re. Spinal canal stenosis:

sometimes the canal will just look overall small suggesting a diagnosis of congenital spinal canal stenosis.  Measurements can be inaccurate and its more of a gestalt call

 

Re. Epidural lipomatosis:

use the STIR to sat out the fat and see the canal for what size it is.  Often if the patient is fat, the epidural fat will be prominent.  This can cause canal compromise.

 

Re. Congenital abn in setting of imperforate anus

Look for spinal cord congenital abn.  Did see a case of tethered spinal cord (conus below L3 or so acc. to RP).  In this case, also look for blunting of the conus vs. pointed appearance.  Look for thickened filum or lipo/myelo meningocele type lesion.  Sacrum might be truncated so count down from C2 to ensure corrert numbering.

Re. Compression Fx:

Always look for the next level.  Usually happen in 2 and 3.  Also over time, they have propensity to increase in number.  Can be metastatic so look for abn of underlying bone, suspicious widening of pedicles.  Consider MR+gad

 

Re. Spondylosis, spondylolisthesis and sponylolysis.

Horrible terminology.  Spondylosis means stiffening like stiff degenerative back, spondylolisthesis is pars defects with slippage, spondylolysis is the pars defect only.

 

 

Re. C spine Trauma:

C5-C6 nondisplaced cervical spine fractures are the most commonly missed, use axials and look at posterior elements

If see one compression fracture including subtle endplate compression fractures, look for the other ones.  Usually come in twos and threes