Radiologic C/S eval

Question 1

List the ABCDs for viewing imaging

Answer 1

• Alignment
• Bone Signal
• Canal Space (also CNS for MRI)
  
  • narrowing/indent (encroachment) in canal from potential structures
• Discs Integrity
• Soft tissues

Question 2

List general indications for CT of the C-Spine (9)

Answer 2

1. Acute trauma (adults)
2. Degenerative conditions
3. Post-op assessment
4. Infection
5. Image-guided intervention procedures
6. Neoplasm
7. Inflammatory lesions
8. Congenital/developmental conditions
9. Cord syrinxes/masses (with MRI contraindicated)

Question 3

what may be best observed with an axial CT of the C-spine?

Answer 3

1. spatial relations → dens and lateral masses, dens and anterior arch
2. atlantodental interface
3. spinal canal

Question 4

what may be best observed with a coronal CT of the C-spine?

Answer 4

1. integrity of the dens
2. spatial relations of C1 and C2
   
   1. a burst fracture or Jefferson’s fracture is best seen in this plane

Question 5

list general indications for MRI of the C-spine

Answer 5

1. Acute trauma with suspected cord encroachment
2. DDD
3. Neoplasm
   
   1. Dx and intervention f/u
4. Intrinsic spinal cord pathology
5. Congenital/developmental conditions
6. Cord masses
7. Post-op assessment (soft tissues, vertebroplasty)
8. Meningeal abnormalities
9. Infection
   
   1. disc space infections
   2. epidural abscess

Question 6

what is myelomalacia? What is the best imaging to see it?

Answer 6

encroachment on the cord from a bulging disc resulting in softening of the spinal cord

best seen with a T2 MRI

Question 7

what does PECARN stand for?

Answer 7

Pediatric Emergency Care Applied Research Network

Question 8

what is PECARN?

Answer 8

a guideline that states → high risk for cervical spine injury (do imaging) if one or more of the following are present:

1. AMS
2. focal neurologic findings
3. Torticollis (new onset)
4. Substantial torso injury
5. Conditions predisposing to cervical spine injury
6. diving
7. high-risk motor vehicle crash

Question 9

list the 4 ACR Appropriateness criteria for the neck

Answer 9

1. Cervical neck pain or cervical radiculopathy
2. Myelopathy
3. Suspected spine trauma
4. Suspected spine trauma - child

Question 10

in general if a child (ages 3-16) has suspected spine trauma and meets criteria (PECARN, NEXUS, Pieretti-Vanmarcke) what is the most appropriate intial study?

Answer 10

radiography of spine area

Question 11

T/F: if imaging is not indicated by NEXUS or CCR for pts ages 16-65 then they don’t need imaging?

Answer 11

TRUE

Question 12

if clinical or imaging findings suggest a ligamentous injury in the neck/cervical region what imaging study is best?

Answer 12

initially - CT

next study - MRI

Question 13

What view can you best see the Z-joints in in the C-Spine vs the T-spine?

Answer 13

C-Spine: lateral

T-spine: Oblique 70

Question 14

What view can you best see the intervertebral foramin in in the C-spine versus the T-spine?

Answer 14

C-spine: oblique 45

T-spine: lateral