SWISSRADIOLOGY.COM

SWISSRADIOLOGY.COM

SWISS RADIOLOGY PORTAL

IRM ouverte
Magnetic Resonance

Scanner
CT-Scan

Radiographie
Digital Radiology

Mammographie
Mammography

Densitométrie
Densitometry

Echographie
Ultrasound / Interventional Radiology

Indication des examensi
Current pathology
imaging guidelines

Caducee@
Swiss Physicians email directory

Astuces
Tips page

Liens
Links

Abbreviations

The Hippocratic Oath

Institute access map

Patient prepararation

Site map

Home

Website in french

CURRENT PATHOLOGY IMAGING GUIDELINES

CONTENTS

A. Neck and thorax

B. Upper abdomen

C. Genitourinary system

D. Vascular system

E. Central nervous system

F. Spine

Imaging resources

Problem management

1. Trauma
2. Infection
3. Tumor
4. Degenerative diseases
5. Malformations, scoliosis

G. Extremities

H. Nuclear Medicine

top

IMAGING RESOURCES

Standing AP and lateral radiographs (very useful before any further imaging)

  • static disorders: pelvis lateral tilt, scoliosis, exagerated kyphosis, hyperlordosis, rigidity, spondylolisthesis, subluxation
  • vertebra and posterior elements: transitional abnormalities, malformations, fracture, avulsion, luxation, lytic or sclerotic lesions, osteopenia, collapse, posterior joint osteoarthritis, spinal stenosis
  • vertebral discs: collapse, intradiscal gas, erosion or sclerosis of vertebral endplates, osteophytes
  • soft tissues: paravertebral swelling, calcifications (post. longitudinal lig., yellow ligaments, annulus fibrosus, nucleus pulposus), paralytic ileus, aorta, etc.
  • Other bone elements: sacrum, coccyx (better demonstrated by a localised lateral view), sacroiliac joints, pelvis, hips

Oblique views

  • in cervical spine: visualisation of foramina, posterior facets
  • in lumbar spine: allows analysis of vertebral isthms (spondylolysis)

Flexion-extension or lateral inclination (after standard views study)

  • may show posttraumatic vertebral or posterior joints subluxation (cervical spine)
  • anteroposterior stability disorders
  • to distinguish a postural from a fixed scoliosis
  • contraindications: fracture or luxation not excluded, dens subluxation (rheumatoid arthritis)

top

Transbuccal projection (A-P)

  • C1-C2 joint
  • dens and ligament lesions

Barsony projection

  • sacroiliac joints (now better analysed by CT-scan)
  • may show a spondylolysis at L5 level
  • sacrum study

Myelography

  • subarachnoidal space opacification through lumbar or suboccipital puncture
  • almost always replaced by MRI sequences

Radiculography

  • lumbosacral sac opacification through lumbar puncture
  • sometimes useful before operation in addition to MRI in an ambiguous case (intraforaminal hernia, suspicion of recurrent disc hernia)
  • often associated to CT-scan (myeloCT)

top

MRI

  • after standard radiographs, best option for all spine segments, especially cervical spine (CT-scan images unsatisfactory due to shoulder artifacts) and long segments (dorsal column)
  • suspicion of disc hernia recurrence after operation
  • bone diseases (infection, inflammation, tumoral infiltration)
  • best depiction of discal disorders, spinal canal lesions (tumors, collections, etc.) and paravertebral spaces
  • myelographic sequences

CT-scan

  • spine trauma
  • good depiction of bony stenoses (older patients, severe osteoarthritis, suspicion of spinal canal stenosis)
  • may be added to a myeloradiculography
  • guidance in interventional radiology (diagnostic puncture, therapeutic infiltration, vertebroplasty)
  • limited field of view, no direct sagittal sections, suboptimal tissue resolution (disc substance), less accurate for recurrent disc hernia
  • most often replaced by MRI for: disc hernias, spondylodiscitis, neoplasia, operated patients

    top

PROBLEM MANAGEMENT

1. Trauma

  • CT-scan with multiplanar reconstructions: trauma work-up
  • Plain films: osteopenia, fracture, bone avulsion, subluxation, luxation, angulation
  • transbuccal: suspicion of dens fracture
  • flexion views (cervical spine): posterior joints instability
  • MRI: cord lesion, posterior wall, pathologic fracture, disc hernia, ligament injury

2. Infection

  • Plain films: disc space narrowing, vertebral endplate erosion, scoliosis, paravertebral swelling
  • MRI: first choice imaging tool for spondylodiscitis, extent of infection, paravetebral spread
  • CT-scan: extent of bony destruction, abscess, guided puncture, drainage
  • scintigraphy: search for occult infection site

3. Tumors

  • Plain films: osteolysis, pathologic fractures, vertebral alignment, distant lesions, vertebral angioma
  • MRI:tumor extension, spinal canal invasion, paravertebral invasion, skip lesions, treatment monitoring
  • CT-scan: bone destruction, posterior elements, specific lesions (osteoblastoma, vertebral angioma, bone sclerosing metastasis), guided diagnostic punctures. Thoraco-abdominal metastatic work-up.
  • scintigraphy: depiction of bone metastases (breast, prostate, lung, kidney, thyroid tumors, etc.)

top

4. Degenerative and inflammatory diseases

  • Plain films: static disorders, malformations, disc space narrowing, osteophytosis, posterior elements osteoarthritits, osteopenia, vertebral collapse, erosion, calcification (DISH), ostéochondrosis (Scheuermann's disease)
  • MRI: radiculalgia with neurological deficit (disc hernia, intracanalar synovial cyst, posterior joints osteoarthritits, foraminal stenosis), prolonged pain not responding to treatment, neurogenic claudication (spinal canal stenosis)
  • CT-scan: may replace MRI for some lumbar spine indications (older or restless patients, complement after radiculography, infiltration guidance)

5. Malformation, scoliosis

  • Plain films (for a scoliosis, 2 segments at least, i.e. cervical+thoracic or thoracic+lumbar, or total spine film); scoliosis angle measurements
  • Obliques ± Barsony: spondylolisthesis
  • Functional views: stability and reversibility of scoliosis, hyperkyphosis or hyperlordosis
  • MRI: Chiari malformation, hydromyelia, tethered cord, sacrococcygian lipoma, meningocele
  • CT-scan: complex vertebral malformations, diastematomyelia, post-operative status (strong metallic elements artifacts against MRI use)
  • ultrasound (infants and small children): posterior arch closing defects and tethered cord.

top


Pierre Bénédict, MD, FMH radiologist, Lausanne, 1997-2018

References:

top