TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 99

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 99. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 982 Section Tumors and Inflammation MRI is the imaging study of choice Magnetic Resonance Imaging Today magnetic resonance imaging MRI provides the most complete information for evaluating a vertebral metastatic lesion and therefore it has become the imaging modality of choice 6 . MRI is both sensitive and specific and is recommended as the initial study in patients with suspected metastatic spinal disease. It clearly provides tumor localization unifocal vs multifocal extent of bony destruction sometimes better seen on CT soft tissue involvement localization of neural compression anterior posterior foraminal The application of contrast medium is helpful when intrathecal metastasis is suspected. Repeat MRI studies can demonstrate evolution of the disease process with minimum discomfort to the patient. Characteristic MRI findings Fig. 3a b suggestive for spinal metastasis are bone marrow replacement with decreased signal on T1- and increased signal on T2-weighted images preservation of disc structure on both T1- and T2-weighted images spinal cord compression on Tl-weighted images compression of subarachnoid space on T2-weighted images contrast enhancement of the metastatic vertebral body Figure 3. MRI characteristics of spinal metastases The predominant findings of spinal metastases are the bone marrow replacement with decreased signal intensity on a T1Wand increased signal on b T2W images the preservation of disc structure on both T1W and T2W images the spinal cord compression on T1W images and the compression of subarachnoid space on T2W images. Spinal Metastasis Chapter 34 983 CT Scans The CT scan is superior only in the assessment of cortical bone and it has nowadays been surpassed by MRI 6 . It can be of value when extensive spinal reconstructions are required to improve preoperative planning. Bone Scans A radionucleotide bone scan of the skeleton is routinely performed as a screening to rule out the presence of metastatic disease in the spine and other areas of

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