lumbar spondylolisthesis

This patient came in with severe low back pain and had multiple diagnoses which may be the problem. One diagnoses which I see from time to time was spondylolisthesis. An article by Mary Rodts, DNP, CNP, ONC, FAAN goes in detail on this condition, which was found on the web at http://www.spineuniverse.com/displayarticle.php/article114.html. This is a condition where one vertebra slips over another. This is found most frequently in lumbar area and is graded by severity on how far it is slipped forward. The grades go from least severe (grade 1) to most severe (grade 5). This patient had a grade 2 almost grade 3 diagnoses which means 50 to 70 percent of the vertebral body has slipped forward. This is a sagittal T2 image of the lumbar spine.

Thoracic Stenosis

Thoracic stenosis is a condition where the spinal nerves or spinal cord is compressed in that region. I recently scanned a patient with back pain and abnormal sensations in their lower extremities. This was an elderly patient which we frequently get orders for to rule compression fracture or spinal stenosis. This patient had a T7-T8 paracentral disc protusion that mildly flattened the ventral aspect on the spinal cord on the right. Disc buldges can cause problems a little easier in the thoracic region due to the naturally narrower spinal canal of the thoracic. I see this in other regions where a patient has a congenital narrower spinal canal such as in cervical region, it immediately is problematic by touching the cord. If that same patient had more room in the canal it may not be as severe.

Cervical Stenosis

This is a common diagnosis in my MRI or probably just about every MRI department. Stenosis means narrowing in medical terminology, so the term cervical stenosis means just that; narrowing of the cervical stenosis. To adequately demonstrate this it is good to see not only in a sagittal plane but the axial plane. This was a patient who previously had surgery for this problem and now has it on several levels. This was a t2 weighted image in the sagittal plane and notice the compression on the spinal cord.

Vertebral Dissection

We had done a young male for stroke like symptoms a while back and he was diagnosed with a vertebral dissection. He was also found to have a few acute ischemic areas in posterior part of the brain on diffusion. Well he seemed to be better when we just followed up on him and did a MRA on his neck. I remembered this case because he was so young and they suspected a neck munipulation from a chiropractor caused it. He was found to still have occluded bilateral vertebrals. It looks like he was lucky and superiorly in the cow portion he was feeding the posterior circulation from the anterior circulation.

SOFT TISSUE NECK IN MR

My MRI department does perform soft tissue exams from time to time, but I have not seen one in a while. I presume a lot of those exams are going to CT. I did perform a MRI procedure recently for a patient with unexplained pain just inferior to mandible. The exam did not demonstrate any pathology which would explain these symptoms but did find an incidental finding of a thyroglossal duct cyst. To be honest I was not sure what this was other than a structure filled with fluid. So I did a quick google search and found some useful information on a website from the University of Virginia Health System http://www.healthsystemvirginia.edu/. It turns out these cysts are formed in embryonic development after the thyroid is developed. They can often enlarge and be painful after certain infections such as respiratory. I like how MR images demonstrate these cysts. Because of the high water content it is very bright on this t2 axial with fat suppression and it showed some enhancement post contrast on a t1 axial image also with fat suppression.

CEREBRAL VENOUS THROMBOSIS

MRI/MRV is the diagnostic tool of choice for this type of pathology at our facility. This is an occlusion of one more parts of the cerebral venous supply that carries blood away from the brain. This can restrict flow and cause a stroke in severe cases and many times can be hemorrhagic according to an article on WWW (HTTP://EMEDICINE.MEDSCAPE.COM/ARTICLE/338750). I have done numerous of these types of studies for patients presenting with headache. I have seen only few positive cases which may be a hand full a year and most had risk factors such as taking oral contraceptives, pregnant, or postpartum. Here is a young female (which was on oral contraceptives) who presented with a severe headache and was found to have a positive finding of a sinus thrombosis. We do both MRI and MRV imaging of the head and brain typically in our protocol. The MRV images shown were just TOF ran perpendicular to flow and with an inferior sat band to avoid arterial flow.

sinuses and facial bones

Typically in MRI we do not do exams for sinus disease or facial bones. However; you can appreciate sinus pathology such as sinusitis. We do frequently use MRI for patients suffering from headaches and often see sinus disease which according to my radiologist is one of the leading causes of headache. He is a patient with an incidental finding of possible sinusitis.

ORBIT PATHOLOGY

We had a patient come in with visual disturbance and pain involving right eye. We did a orbit protocol that involves brain sequences as well high resolution, thinner cuts of the orbits. We did these sequences pre and post contrast. This patient had abnormal enhancement in right globe involving the optic nerve and medial rectus muscle.

Pituitary Disorders

Pituitary disorders; such as, pituitary microadenoma's or pituitary macroadenoma's are a common pathology in MRI. At our facility, we do routine brain sequences; as well as, high resolution and smaller FOV images of the pituitary to screen for these disorders. We give contrast to see how the gland enhances verses the tumor. This can be tricky since the pituitary enhances normally. To help eliminate this difficulty we like to give a half dose and scan immediately or dynamically post contrast. These disorders are benign in nature but can cause multiple problems. If the tumor is more than 10 mm than it is considered macroadenoma. If is less than 10mm it is considered microadenoma.

Vestibular Schwannoma

This was on a patient who was complaining of hearing loss and when tested it was found to be one sided. In MRI we have an IAC protocol for patients suspected of some growth on the 7th and 8th nerve. We do thin high res imaging of the area of interest. Here are some pics on a recent positive case. One image is a fiesta 3d image (GE Scanner) and a T1 axial post contrast. These benign tumors are slow growing and called Acoustic Neuroma or Vestibular Schwannoma.

MULTIPLE SCLEROSIS

I never really understood anything about this disease until I started working in MRI. MRI is a commonly used modality for detection of MS plaques and now I have found that is much more prevalent than I thought. MS plaques can appear as hyper-intensities on T2 imaging. It can be in the brain or spinal cord. It attacks the myelin that covers nerve fibers. When scanning for MS in the brain our protocol is additional T2 FLAIR imaging in a sagittal plane. Flair uses an inversion pulse which makes CSF dark making T2 hyper-intense plaques "stand out". Our radiologist looks in the white matter where myelin is found and for a pattern scattered away from corpus callosum. We typically give contrast to see if any plaques enhance that may represent an "active plaque". We also like to do delayed post contrast imaging because some experts believe MS plaques do not enhance until a delayed phase.

INTRODUCTION

My name is Jason Prater. I am currently employed as a MRI Technologist and working towards a bachelors’ degree. I would like to pursue another direction for my career in the future. I would like to see more of a leadership role such as a radiology director or even get into teaching. I was a clinical instructor for Radiography part time and enjoyed working with students. Either way, I am looking to learn new ideas and review others while earning a 4 year degree!