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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



    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)


    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


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


    • 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)



    • 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


    • 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



    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.)


    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.


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