MRI of the Spine: A Guide for Orthopedic Surgeons

269 Pages·2020·22.397 MB·English

by  William B. Morrison, John A. Carrino, Adam E. Flanders

MRI of the Spine
A Guide for Orthopedic Surgeons
William B. Morrison
John A. Carrino
Adam E. Flanders
Editors
123
MRI of the Spine
William B. Morrison
John A. Carrino • Adam E. Flanders
Editors
MRI of the Spine
A Guide for Orthopedic Surgeons
Editors
William B. Morrison John A. Carrino
Division of Musculoskeletal Radiology Department of Radiology and Imaging
Thomas Jefferson University Hospital for Special Surgery
Philadelphia, PA New York, NY
USA USA
Adam E. Flanders
Division of Neuroradiology
Thomas Jefferson University
Philadelphia, PA
USA
ISBN 978-3-030-43626-1 ISBN 978-3-030-43627-8 (eBook)
https://doi.org/10.1007/978-3-030-43627-8
© Springer Nature Switzerland AG 2020
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For Binx and Boots
–William B. Morrison
Preface
MRI of the Spine is a book concept that arose from a spine imaging instruc-
tional course at the annual meeting of the American Academy of Orthopaedic
Surgeons. The course has been the only dedicated radiology-based course at
the AAOS meeting over the past decade, with radiology faculty and organiz-
ers. This unique arrangement reflects a need in the orthopaedic community,
education on MR imaging, which has become an essential component of the
diagnostic algorithm. Spine imaging incorporates degeneration, trauma,
inflammatory conditions and infection, metabolic conditions, as well as dural
and cord lesions, including neoplasia. An understanding of the MR imaging
appearances of these conditions will assist the orthopaedist in understanding
the nature and extent of the patient’s condition. Following surgery and altera-
tion of anatomy, MR imaging can be especially challenging to interpret. This
is explored, with expected post- operative appearances and findings suggest-
ing recurrent or new pathology. An understanding of methods for acquiring
the images can also be helpful – what protocol to use and utility of contrast in
different situations. To this end, we also provide tips for optimization of the
MR imaging protocol. The editors and authors are musculoskeletal radiolo-
gists and neuroradiologists who work closely with surgeons in direct patient
care. Our goal is to create a bridge between the radiologist and the orthopae-
dist, together using cutting-e dge technology to better care for our patients.
Philadelphia, PA, USA William B. Morrison
New York, NY, USA John A. Carrino
Adam E. Flanders
vii
Contents
1 MRI Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Vishal Desai and Jehan Ghany
2 MRI in Spine Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Ajit Karambelkar
3 MRI in Spine Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Phan Q. Duy, Ichiro Ikuta, Michele H. Johnson,
Melissa Davis, and Vahe M. Zohrabian
4 MRI in Degenerative Disease of the Spine . . . . . . . . . . . . . . . . . . 87
Alessandra J. Sax
5 MRI in Spine Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
M. K. Jesse and Corey K. Ho
6 MRI in Non-infectious Inflammation and Arthropathies . . . . . . 129
Sachin Dheer
7 MRI in Metabolic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Ricardo Hernandez, Philip K. Wong, Monica Umpierrez,
and Felix M. Gonzalez
8 MRI in Neoplastic Bone Disease and Differential
Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
John V. Dennison, Alexander Leyva, Andrew T. Cibulas,
Kurt F. Scherer, Jack A. Porrino, Sean C. Dodson,
Richard D. Beegle, and Laura W. Bancroft
9 MRI in Dural Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Mougnyan Cox
10 MRI in Cord Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Kofi-Buaku Atsina
11 Principles of Postoperative Spine MRI . . . . . . . . . . . . . . . . . . . . . 237
Karthik Krishnan, Sophie C. Queler, and Darryl B. Sneag
12 Identification of Complications Using Postoperative
Spine MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Prabath Kumar Mondel
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
ix
Contributors
Kofi-Buaku  Atsina, MD Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, PA, USA
Laura W. Bancroft, MD, FACR University of Central Florida School
of Medicine, Orlando, FL, USA
Florida State University School of Medicine, AdventHealth, Orlando, FL,
USA
Richard D. Beegle, MD Department of Diagnostic Radiology, AdventHealth,
Orlando, FL, USA
Andrew T. Cibulas, MD AdventHealth GME Radiology, Orlando, FL, USA
Mougnyan  Cox, MD Hospital of the University of Pennsylvania,
Philadelphia, PA, USA
Melissa Davis, MD, MBA Department of Radiology & Biomedical Imaging,
Yale School of Medicine, New Haven, CT, USA
John V. Dennison, MD AdventHealth GME Radiology, Orlando, FL, USA
Vishal Desai, MD Thomas Jefferson University, Philadelphia, PA, USA
Sachin Dheer, MD Department of Radiology, Thomas Jefferson University
Hospital, Jefferson Health, Philadelphia, PA, USA
Sean C. Dodson, MD Department of Diagnostic Radiology, AdventHealth,
Orlando, FL, USA
Phan Q. Duy, BS Department of Radiology & Biomedical Imaging, Yale
School of Medicine, New Haven, CT, USA
Jehan Ghany, MD Thomas Jefferson University, Philadelphia, PA, USA
Felix M. Gonzalez, MD Department of Radiology and Imaging Sciences,
Emory University Hospital, Atlanta, GA, USA
Emory University Orthopaedics & Spine Center, Atlanta, GA, USA
Ricardo Hernandez, MS-III Philadelphia College of Osteopathic Medicine,
Suwanee, GA, USA
Corey K. Ho, MD University of Colorado Anschutz Campus, Aurora,
CO, USA
xi
xii Contributors
Ichiro  Ikuta, MD Department of Radiology & Biomedical Imaging,
Yale School of Medicine, New Haven, CT, USA
M. K. Jesse, MD University of Colorado Anschutz Campus, Aurora, CO,
USA
Michele H. Johnson, MD Department of Radiology & Biomedical Imaging,
Yale School of Medicine, New Haven, CT, USA
Ajit Karambelkar, MBBS, MD Thomas Jefferson University Hospital
Philadelphia, Philadelphia, PA, USA
Karthik  Krishnan, MS Weill Medical College of Cornell University,
New York, NY, USA
Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY, USA
Alexander Leyva, MD AdventHealth GME Radiology, Orlando, FL, USA
Prabath Kumar Mondel, MBBS, MD Philadelphia, PA, USA
Jack A. Porrino, MD Yale School of Medicine – New Haven Hospital,
New Haven, CT, USA
Sophie C. Queler, BA Department of Radiology and Imaging, Hospital for
Special Surgery, New York, NY, USA
Alessandra  J.  Sax, MD Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, PA, USA
Kurt F. Scherer, MD University of Central Florida School of Medicine,
Orlando, FL, USA
Florida State University School of Medicine, AdventHealth, Orlando,
FL, USA
Darryl  B.  Sneag, MD Weill Medical College of Cornell University,
New York, NY, USA
Department of Radiology and Imaging, Hospital for Special Surgery,
New York, NY, USA
Monica Umpierrez, MD Department of Radiology and Imaging Sciences,
Emory University Hospital, Atlanta, GA, USA
Philip K. Wong, MD Department of Radiology and Imaging Sciences,
Emory University Hospital, Atlanta, GA, USA
Vahe M. Zohrabian, MD Department of Radiology & Biomedical Imaging,
Yale School of Medicine, New Haven, CT, USA
1
MRI Protocol
Vishal Desai and Jehan Ghany
Introduction MRI Physics
Magnetic resonance imaging (MRI) is the main- To get a better understanding of the commonly
stay for noninvasive evaluation of the spine, pro- performed MRI sequences and what information
viding detailed anatomical assessment and can be extracted from each, an overview of MRI
excellent sensitivity for pathology, including physics is helpful [1]. MRI utilizes the body’s
degenerative disc disease, tumors, infection, natural magnetic properties for imaging, specifi-
bone marrow processes, spinal cord abnormali- cally the hydrogen nucleus due to its prevalence
ties, traumatic injuries, and compression frac- throughout the body in water and fat.
tures. Unlike other imaging modalities, MRI can
evaluate the spinal cord, meninges, cerebrospi-
nal fluid, marrow, and supporting structures in Magnetic Field
one routine study.
Advanced MR imaging can be obtained with Hydrogen protons contain a net positive charge,
additional sequences and/or with intravenous providing them with their own magnetic spins
contrast to gather more information, help with and a local magnetic field. With the patient in
troubleshooting, or assist in evaluating patients the MRI scanner, a uniform magnetic field is
with prior spinal surgery with or without hard- applied to the protons in the slice or slab of
ware. The high yield of MRI and the lack of ion- interest, causing the randomly oriented protons
izing radiation make it the imaging modality of to now align parallel to the external magnetic
choice for the spine in nearly all populations and field, precess at a certain frequency, and contain
for most indications. a net magnetization in the longitudinal direc-
tion (Fig. 1.1).
RF Pulse
Next, a radiofrequency (RF) pulse or series of RF
pulses is applied to the protons, dependent on the
sequence and information desired. The energy
V. Desai (*) · J. Ghany from the RF pulse is absorbed by the protons,
Thomas Jefferson University, Philadelphia, PA, USA
causing the net magnetization to tilt away
e-mail: [email protected];
[email protected] from the longitudinal direction (Fig.  1.2).
© Springer Nature Switzerland AG 2020 1
W. B. Morrison et al. (eds.), MRI of the Spine, https://doi.org/10.1007/978-3-030-43627-8_1