Podcast
Questions and Answers
What is a characteristic feature of a fracture as opposed to a vascular marking?
What is a characteristic feature of a fracture as opposed to a vascular marking?
How do fracture lines appear on an X-ray compared to sutures?
How do fracture lines appear on an X-ray compared to sutures?
What view is specifically used for assessing the maxillary sinus?
What view is specifically used for assessing the maxillary sinus?
What indicates acute sinusitis on an X-ray?
What indicates acute sinusitis on an X-ray?
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What anatomical structure is most likely to block drainage leading to sinusitis?
What anatomical structure is most likely to block drainage leading to sinusitis?
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What is NOT a characteristic of sutures as compared to fractures?
What is NOT a characteristic of sutures as compared to fractures?
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Which of the following correctly describes the occlusion of the osteomeatal complex?
Which of the following correctly describes the occlusion of the osteomeatal complex?
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What issue is commonly associated with allergic rhinitis that can lead to sinusitis?
What issue is commonly associated with allergic rhinitis that can lead to sinusitis?
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Which imaging technique provides better anatomical and pathological details than X-ray?
Which imaging technique provides better anatomical and pathological details than X-ray?
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What position should a patient be in during a CT examination for the paranasal sinuses?
What position should a patient be in during a CT examination for the paranasal sinuses?
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Which condition can be indicated by air fluid levels in the maxillary sinus?
Which condition can be indicated by air fluid levels in the maxillary sinus?
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Which of the following is NOT evaluated in plain radiographs of the spine?
Which of the following is NOT evaluated in plain radiographs of the spine?
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What is the normal alignment of the spine?
What is the normal alignment of the spine?
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In which view is the intervertebral foramen, where nerve roots exit, assessed?
In which view is the intervertebral foramen, where nerve roots exit, assessed?
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A 'collar in the Scottish dog neck' on imaging indicates which condition?
A 'collar in the Scottish dog neck' on imaging indicates which condition?
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How does osteoporosis appear in terms of bony texture on radiographs?
How does osteoporosis appear in terms of bony texture on radiographs?
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What is the term for the fracture of the pars interarticularis?
What is the term for the fracture of the pars interarticularis?
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What is a potential consequence of bilateral fracture of the pars interarticularis?
What is a potential consequence of bilateral fracture of the pars interarticularis?
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Which factor is NOT a cause of spondylolisthesis?
Which factor is NOT a cause of spondylolisthesis?
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Which age group is primarily associated with grade 1 spondylolisthesis?
Which age group is primarily associated with grade 1 spondylolisthesis?
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What does the pars interarticularis primarily connect?
What does the pars interarticularis primarily connect?
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Which type of spondylolisthesis is commonly observed in older females?
Which type of spondylolisthesis is commonly observed in older females?
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What is the strongest risk factor for developing spondylolysis based on grade?
What is the strongest risk factor for developing spondylolysis based on grade?
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What typically represents the weakest part of a vertebra?
What typically represents the weakest part of a vertebra?
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What does the presence of adequate CSF anterior and posterior to the spinal cord indicate?
What does the presence of adequate CSF anterior and posterior to the spinal cord indicate?
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Which cause is NOT associated with spinal canal stenosis?
Which cause is NOT associated with spinal canal stenosis?
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What does a darker disc on an MRI T2 indicate?
What does a darker disc on an MRI T2 indicate?
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Which imaging technique is most useful for assessing spinal bone marrow and fractures?
Which imaging technique is most useful for assessing spinal bone marrow and fractures?
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What is a sign of severe spinal canal stenosis as per the imaging description?
What is a sign of severe spinal canal stenosis as per the imaging description?
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What does a 'mass effect' on the thecal sac in cervical spine MRI suggest?
What does a 'mass effect' on the thecal sac in cervical spine MRI suggest?
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In MRI evaluation, which condition shows a whiteness inside the spinal cord due to severe compression?
In MRI evaluation, which condition shows a whiteness inside the spinal cord due to severe compression?
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Which imaging view is crucial for assessing the spinal canal for stenosis?
Which imaging view is crucial for assessing the spinal canal for stenosis?
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What is the confirmatory method for diagnosing cold abscesses of the spine?
What is the confirmatory method for diagnosing cold abscesses of the spine?
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Which imaging technique is preferred for detecting abnormalities in spinal infections?
Which imaging technique is preferred for detecting abnormalities in spinal infections?
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What abnormal finding is associated with T11/L2 spondylodiscitis?
What abnormal finding is associated with T11/L2 spondylodiscitis?
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What does the presence of a kyphotic deformity in the spine indicate?
What does the presence of a kyphotic deformity in the spine indicate?
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What distinguishes cold abscesses from other bacterial infections?
What distinguishes cold abscesses from other bacterial infections?
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What is the most common cause of disc herniation in the elderly?
What is the most common cause of disc herniation in the elderly?
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Which condition is commonly referred to as Pott's disease?
Which condition is commonly referred to as Pott's disease?
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What spinal condition is characterized by infection of both the vertebrae and the disc?
What spinal condition is characterized by infection of both the vertebrae and the disc?
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Which imaging technique uses contrast to enhance visibility of structures such as the kidneys?
Which imaging technique uses contrast to enhance visibility of structures such as the kidneys?
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The central canal narrowing caused by disc herniation at C4-C5 and C5-C6 indicates what kind of effect?
The central canal narrowing caused by disc herniation at C4-C5 and C5-C6 indicates what kind of effect?
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At what level does counting begin when evaluating the cervical spine?
At what level does counting begin when evaluating the cervical spine?
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What term describes an enlarged psoas muscle with abnormal signal on imaging?
What term describes an enlarged psoas muscle with abnormal signal on imaging?
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What type of infection affects only the discs without involving the vertebrae?
What type of infection affects only the discs without involving the vertebrae?
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Study Notes
Neuroradiology Study Notes
- Doctor's and patient notes from PowerPoint presentations were compiled and included in the slides.
- Additional notes and clarifications were added by [email protected].
- Original work by Professor Essam Abdulbary and Dr. Maram served as a baseline for the lecture.
Objectives
- Recognize various imaging modalities used in neuroimaging.
- Understand basic brain cross-sectional anatomy.
- Identify and describe common pathologies.
- Learn about red flag cases.
Imaging Modalities
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Plain X-ray
- Ultrasound (transcranial)
- Cerebral angiography
- Myelography
- Isotope scanning
- Interventional procedures
Commonly Used Examinations
- Transcranial ultrasound (US) is primarily used for infants due to the open fontanel to avoid ionizing radiation.
- Cerebral angiography (conventional angio) has been superseded by CT angiography. It is invasive and requires sedation and is used before procedures like aneurysm repair.
- Myelography is invasive and is now replaced by MRI except for when MRI is contraindicated. A contrast agent is injected into the thecal sac followed by CT or X-rays.
- Isotope scanning assesses brain function and helps confirm brain death or degenerative diseases such as Alzheimer's.
- Interventional procedures (aneurysm repair, thrombolysis, thrombectomy) are discussed separately.
Plain X-ray Views
- Skull X-rays have been replaced by CT.
- Occipitofrontal views (X-ray from posterior to lower exposure to the eye) are used for skull examination.
- Standard views include PA (occipitofrontal), lateral (right & left), and sinus (occipitomental or water's view) for skull.
- Vertebral column views consist of AP, lateral, and oblique views.
Plain X-ray Findings and Significance
- Plain skull films may reveal lytic deposits (multiple myeloma), fractures, abnormal calcifications (meningioma, glioma, AVM, post-infective foci), and pituitary fossa enlargement. In X-rays, focus is not on detailed anatomy.
- Important anatomical features (suture lines, sinuses, bones) are shown in plain X-ray views.
- Lateral views detail the frontal bone, frontal sinus, orbital plates, cribiform plate, sphenoid sinus, and maxillary sinus.
- Important anatomical features (sutures, sinuses, bones) are shown.
Fracture and Vascular Markings
- Fractures are characterized by well-defined sharp edges that end at sutures and rarely branch, located at the site of trauma and with clinical history of trauma.
- Vascular markings are less defined, cross sutures, and appear tortuous and branching, located anatomically at sites where vessels can be found.
- Fracture lines are smoother lines than vascular markings.
Water's View
- Water's view is used to assess paranasal sinuses, and specifically the maxillary sinus, nasal septum, and odontoid process (C2), frontal sinus.
- Water's view has been replaced by CT for paranasal sinus examination.
Sinusitis (Air Fluid Level)
- Air fluid level in the maxillary sinus suggests acute sinusitis.
Sinusitis (Air Fluid Level) - CT
- Enlarged turbinates due to allergic rhinitis can block sinus drainage, leading to sinusitis.
- Osteomeatal complex blockage impacts sinus drainage and can trigger sinusitis.
- Septal deviation (deviated septum) and hypertrophied turbinates are causes of sinusitis.
- Complications such as orbital cellulitis, abscess, meningitis, brain abscess, and venous sinus thrombosis can occur.
- Air bubbles and opacification in the maxillary sinuses or an air-fluid level in one suggests sinusitis.
Spinal Radiographs (AP, Lateral, & Oblique Views)
- Alignment (lordosis, kyphosis, straightening)
- Bone texture (normal, osteoporosis)
- Disc spaces (maintained, narrowed)
- Fat outlining the psoas muscle
- Paravertebral shadows (dorsal spine)
- Sacroiliac joints (lumbar spine - psoriasis)
- Cone view
- Examination views consist of AP, Lateral oblique , and Cone views.
Spinal Radiographic Findings & Significance
- Cone view used, predominantly for assessment of the L5-S1 disc
- Spine alignment (lordosis, kyphosis, cervical lordosis) is important.
- Bone texture assesses osteoporosis.
- Paravertebral shadows can indicate tumors.
Spondylolysis and Spondylolisthesis
- Spondylolysis: a defect in the pars interarticularis (portion of the vertebral arch)
- Most cases of spondylolysis occur in the lower lumbar vertebrae (L5).
- Spondylolysis can lead to spondylolisthesis (forward slippage of one vertebra).
- Causes of spondylolysis include: repeated microtrauma (especially in adolescent athletes), congenital abnormalities, weak bones in postmenopausal women (due to osteoporosis), trauma, tumors, and infections.
Cervical Spine (AP, Lateral, & Oblique Views)
- Assessment of cervical spine concerns the vertebral bodies; anterior, posterior, and transverse processes; vertebral foramina; articular processes and facet joints; and disc spaces.
Cross-Sectional Imaging of the Spine
- Assessment includes fracture analysis, bone texture appraisal, facet joint analysis (OA), disc lesion identification, spinal cord and infection analysis, and spinal neoplasm identification.
CT Scan
- Fractures, bone texture, facet joints (OA), spinal cord, infections, and tumors are evaluated.
Cut Spine
- Patient lies supine during CT scan.
- Axial cuts are taken.
- 3D image reconstruction is possible.
- Facet joint, Spinal canal, OA presence or absence is evaluated.
- Space between disc & posterior process is measured for spinal canal stenosis.
Bone Window vs. Soft Tissue Windows
- Bone window is used to differentiate bone density.
- Soft tissue window is used to show soft tissues.
- Cortical bone is clear in CT.
MRI (T1 and T2 weighted images)
- MRI is a highly detailed imaging method showing higher soft tissue resolution, excellent for recognizing bone marrow lesions and spinal cord pathology.
- CT scans have higher bone density definition than MRI scans which are denser for bone showing.
- Disc features, bone marrow integrity, and presence of coda equina are evaluated in MRI.
Degenerative Disc Changes
- X-ray, CT, and MRI show different features of degenerative disc disease.
- Loss of disc height, disc herniation, nerve compression are indications on MRI.
Tuberculosis of Spine (Pott's Disease)
- Infection of the vertebrae (spondylitis) or disc (discitis) or both (spondylodiscitis)
- Symptoms typically include gradual onset of constitutional symptoms such as night sweats, fever, anorexia, weight loss, and other symptoms; however, the presentation may not always be so pronounced given possible atypical manifestations.
- Pathogenesis is bacterial, viral, fungal, or parasitic.
- Can be seen in the thoracis or first lumbar vertebra predominantly.
- Imaging and aspiration/culture confirm diagnosis.
How to Diagnose Spinal Canal Adequacy/Stenosis (in MRI)
- Adequacy/stenosis in the spinal canal is evaluated using T2 weighted imaging.
- The amount of CSF anterior and posterior to the spinal cord is assessed.
- One-sided loss of CSF indicates mild stenosis; bilateral loss, a severe stenosis.
- Causes of narrowing include disc lesions, tumors, and hypertrophy of the ligamentum flavum.
Additional Points
- Details on specific views, terminology, and relevant conditions are provided.
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