L3 L4 Axial CT Scan and Coronal Reformatted View reveal a Markedly Comminuted Fracture of the Atlas with Lateral Displacement of the Left Lateral.

Prepared By:Ala’a Ali Tayem Abed

Computed Tomography – II

RAD - 473

Spinal CT Scan

Spinal CT Scan

A CT Scan of the Spine may be Performed to: • Look at the Bones of the Spine (Vertebrae).• Assess the Spine for a Herniated Disk.• Low Back Pain.• Tumors and Other Lesions.• Injuries and Fractures.• Structural Anomalies such as Spina Bifida (a type of Congenital Defect of the Spine).• Degenerative Spine Disease, such as; Spinal Stenosis, Spondylolisthesis.• Blood Vessel Malformations.• Other conditions, particularly when another type of examination, such as X-rays or physical examination, is not conclusive.• CT of the Spine may also be used to Evaluate the Effects of Treatment of the Spine, such as Surgery or Other Therapy.

Protocol: Patient Position: Supine, for Dorsal and Lumber Spine; Arms Elevated Above Head. Topogram Direction: Craniocaudal. Scan Range: Include Region of Interest and Known Landmark for Level Identification. Make sure to Include the Complete Spinous processes.

COVERAGE: 1. C - Spine: Base of skull to Top of T3.

2. T - Spine: Bottom of C6 to Top of L2.

3. L - Spine: Bottom of T10 to Top of Sacrum. Breath Hold: Suspend Expiration. KV / effective mAs / Rotation time (sec):120kv / 300mAs / 0.75 sec FOV: Field of view must remain the same during the scan. The vertebrae should be centered in the field of view. Include the complete Spinous processes and transverse processes of the vertebrae of interest in the scan. Do not include the pelvis and ribs in the field of view (if possible) Do not include the table in the field of view. Do not include more tissue than necessary; only bone structure should be visible.

L3 L4

Slice Thickness: 3 – 7.5 mm. Contrast: 100cc Omni 300, if needed. Contrast Rate: 2.5 to 3.0 cc per sec. Arterial: 15-20 sec ( for Angiogram of Neck – Thin Slice), or use Bolus Tracking Technique. Venous : 70 sec Delay. Reconstruction: 1. Spine Bone: 3mm x 3mm, 60 Sharp, (WL=1500, WW=300). 2. Spine Soft Tissue: 3mm x 3mm, 31 Medium. 3. Thin Spine: 0.75mm x 0.7mm, 70 Very Sharp for MPR. Reformation: 1. Reformat the Sagittal off of Coronals, and Coronal off of Sagittal. 2. For spines that are very curved additional reformats may be needed.

Axial CT Scan and Coronal Reformatted View reveal a Markedly Comminuted Fracture of the Atlas with Lateral Displacement of the Left Lateral Mass.

Spinal FracturesC - Spine

Sagittal Reconstruction of a CT Scan Showing a Cervical Fracture with Dislocation at the Level of C6/7

CT Scan coronal reconstruction of the cervical spine illustrating a burst fracture of the bodies of C4 and C5.

Spinal FracturesC - Spine

These are two reformatted CT images of the cervical spine. The green arrows point to a transverse fracture of the base of the dens (odontoid). The red arrow points to the same fracture of the sagittal reformatted image. The dens is displaced slightly posteriorly on the body of C2.

Spinal FracturesT - Spine

CT scan - Sagittal (T4 fracture dislocation and L4 fracture ).

CT image shows a severe displaced fracture through the third upper thoracic spine (arrow) in a decedent who suffered multiple injuries in a motor vehicle accident.

A CT scan taken from the side of a fracture-dislocation in the thoracic spine.

Spinal FracturesT - Spine

CT scan image of a fracture of the 5th thoracic spine after a motor vehicle collision.

Spinal FracturesL - Spine

Computed Tomography (CT) Scan of the Lumbar Spine (Shown by Compression Fracture of the Spine).

A CT Scan taken from the Side of a Burst Fracture in the Lumbar Spine.

CT scan was performed and showed a fracture-dislocation centered on L4 vertebra.

Spinal FracturesL - Spine

CT scan shows a collapsed, compressed osteoporotic fracture.

Initial sagittal computed tomography scan showing herniation of the C5-C6 calcified disk located at the central and posterior border (arrow) (A). Axial computed tomography scan (B) showing a dense calcification in the nucleus pulposus, which is located centrally in the Intervertebral disk. A mass in the calcified nucleus pulposus has a right posterolateral extrusion into the spinal canal (arrow).

Herniated Disk, C - Spine

Axial and Sagittal CT scans of T6-T7.There is a calcified disc protruding into the spinal canal, extending from the midline and more prominent to the left.

Herniated DiskT - Spine

Herniated DiskL - Spine

Preoperative CT-scans depicting a large herniated disc fragment with upward and foraminal extension and degenerative spondylolisthesis.

This sagittal reconstruction of the lumbar spine obtained following a lumbar discogram shows contrast, (white), within the L4/5 disc which has a normal appearance. The appearance of contrast within the L5/S1 disc is abnormal demonstrating a degenerated disc with a mild posterior disc protrusion/herniation.

CT Myelogram of lumbar spine: The double arrows point to a split cord malformation (diastematomyelia). Also seen is an incomplete closure of the spine's lamina (spin bifida) that single arrow points to.

Magnetic resonance imaging (MRI) scan of a sagittal section - Spina bifida.

Spina Bifida

Sagittal CT through the lumbar spine revealing an additional lucent line in the posterior elements of the L4 vertebral body (black arrow).

Spondylolysis

The CT scan shows the relevant anatomy of a normal pars interarticularis and one that exhibits spondylolysis.

Spondylolysis

Midline sagittal CT scan again demonstrates the L5-S1 spondylolisthesis.

Spondylolisthesis

Preoperative sagittal CT scan showing spondylolisthesis.

CT scan – C5 spondylolisthesis. CT scan – C5 spondylolisthesis postoperative.

Spondylolisthesis

Non- contrast CT Scan of the entire spine shows diffuse multiple osteolytic lesions.

Spinal Lesions

CT scan, Tumor at C2-C3

C2

C3

Spinal Lesions, C - Spine

Bone metastases: Sagittal CT of the thorax in bone windows shows multiple sclerotic and lytic foci within the thoracic spine vertebral bodies (arrows).

Reconstruction images of the CT chest showing multiple osteoblastic lesions in thoraco-lumbar vertebrae.

Skeletal changes in myeloma, thoracic spine.

Spinal Lesions, T - Spine

Sagittal (A) and axial (B) computed tomography scans showing an osteolytic lesion surrounded by partial sclerotic change of the L4 vertebral body.

Spinal Lesions, L - Spine

Sagittal CT reformation of the lumbar spines (a) shows a large sclerotic lesion nearly completely involving the L5 vertebral body.

Angiography of the neck vessels (coronal section) using computed tomography showed a normal right vertebral artery (long arrow) and a markedly attenuated signal in the left vertebral artery with a long-segment thrombus (short arrows).

CT angiography of the neck shows a long-segment occlusion (red arrows) of the right vertebral artery from C6 up to base of the skull.

Angiography - Vertebral Artery

CT scan of a patient after anterior cervical discectomy & fusion (ACDF) with allograft.

Post-operative CT scan showing screws and plate in cross-section.

Post-Treatment Images

Chest radiograph 7 years postoperatively showing an atelectatic region in the right thoracic cavity almost recovered (A). Lateral radiograph of the thoracic spine (B). Reconstructed sagittal computed tomography scan showing complete bony fusion at the reconstruction site (C).

Post-Treatment Images

Post-op axial CT scans showing cage and pedicle screw placement.

Post-op sagittal CT scan (left) and coronal CT scan (right) showing adequate spondylolisthesis reduction.

Post-Treatment Images

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Best Wishes For All