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Lumbar Spine MRI
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Interpretation
Before doing anything, first verify patient identification and the date of scan
T1 Sagittals
In T1, spinal fluid is dark and fat is bright. Determine the left-right orientation. On the left, the gives off branches at ~L1. On the right, the renal artery runs posterior to IVC. The Aorta is wider than IVC.
Working from caudal to rostral observe:
- Neural foramina and nerve roots: nerve contact and compression.
- Intervertebral discs: width, protrusions/ herniations.
- Spinal column: alignment (spondylolisthesis), vertebral body shape (compression fractures, Schmorls’ nodes), posterior bony elements (spondylolysis), degenerative end plate changes (changes in fat content), hemangiomas.
- Retroperitoneal space: adenopathy, masses, great vessel aneurysm, etc
T2 Sagittals
In T2, spinal fluid is bright.
Working from caudal to rostral observe:
- Dural sac—cord and rootlets: width, compression, irregularities
- Intervertebral discs: width, protrusions/ herniations, hydration, high intensity zones
- Spinal column: alignment (spondylolisthesis), vertebral body shape (compression fractures, Schmorls’ nodes), posterior bony elements (spondylolysis), degenerative end plate changes (changes in fat content), hemangiomas.
- Posterior bony elements: breakage, listhesis, pseudo-articulations, etc.
T1 Axials
The CSF appears gray and fat appears bright. Proceed caudal to cranial.
Orientation – neural foramina lie at level of discs.
- Content of the spinal canal and neural foramina: Trace course of nerve roots through neural foramina
- Intervertebral discs— continuity, bulges, etc.
- Bone – Vertebral bodies; spondylolisthesis, posterior bony elements (spondylolysis, breakage)
- Ligamentam flavum: thickened appearance, impingement
- Retroperitoneal space: adenopathy, masses, muscle, etc.
T2 Axials
Spinal fluid appears bright. Proceed caudal to cranial.
- Content of the spinal canal and neural foramina: Trace course of nerve roots through neural foramina
- Intervertebral discs— continuity, bulges, etc.
- Bone – Vertebral bodies; spondylolisthesis, posterior bony elements (spondylolysis, breakage)
- Ligamentam flavum: thickened appearance, impingement
- Retroperitoneal space: adenopathy, masses, muscle, etc.
Assessment
Ensure you have covered all structures. Assess need for other studies
References
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
