Medical Imaging of Spinal Diseases

Abstract

For the diagnosis of spinal diseases, X-rays are the first line of a routine inspection. You can first understand the spinal bony structures, but the information is limited. CT shows the spinal bony changes, the spinal canal, and neuroforamina, but CT cannot evaluate the spinal cord. MRI is the most important tool for the diagnosis of spinal diseases because MRI can see the spinal bony structures and intervertebral discs, and only MRI can see the spinal cord. Degenerative spondylosis is the most common spinal disease; however, the clinical symptoms have significant variations; many persons have degenerative spinal changes but do not have significant symptoms. X-rays can be routinely examined. You can see spine osteophytes, spondylolisthesis, scoliosis, compression fracture, etc. through X-ray. For more severe patients, we consider CT or MRI. CT can look at the degenerations of vertebral bodies, discs, facet joints and ligaments, and spinal canal stenosis in detail. MRI is especially indicated for the evaluation of cervical and thoracic degeneration because of the need to see the spinal cord. For spinal injury, CT can evaluate the fractures, subluxation. Sagittal and coronal reconstructions of spine CT images are vital for spinal injury. MRI surpasses CT for spinal trauma. T1WI is sensitive to vertebral fractures. Combine T1WI and T2 STIR, MRI can distinguish new and old fractures and detect whether there is edema or bleeding in the spinal cord. For the diagnosis of a spinal tumors, MRI is the most important modality. For intramedullary tumors, only MRI can see the tumor mass and associated syringomyelia. There is a CSF space-widening sign for MRI to distinguish the intradural extramedullary tumor and spinal cord. For spinal metastases, MRI is more sensitive than CT. Osteomyelitis often combines with discitis, called spondylodiscitis. Myelitis may present linear hyperintensity in the spinal cord seen in T2WI, sagittal section. The enteroviral myelitis shows symmetrical hyperintensity in the bilateral ventral horns of the spinal cord seen in axial section.