Neuroimaging in the Patient with Pain

CHAPTER 8 NEUROIMAGING IN THE PATIENT WITH PAIN



Howard S. Smith, MD, FACP




1. What is the radiographic appearance of spinal metastases?


One of the earliest signs of spinal metastasis that may be seen on plain radiographic films is erosion of a pedicle. Eventually, the vertebral body begins to lose height, and magnetic resonance imaging (MRI) may reveal changes in the signal intensity in the vertebral body. Progression of tumor may invade the epidural space and compress the spinal cord.



2. What is a common difference between the MRI appearance of vertebral body destruction caused by vertebral metastases versus that caused by vertebral osteomyelitis?


Tumors affecting the vertebral bodies tend to spare the disc spaces. Despite the fact that two or three adjacent vertebral bodies may be destroyed by tumor, the disc spaces between them tend to be preserved. In vertebral osteomyelitis, the disc space is generally destroyed by the infection and the adjacent vertebral bodies appear to form a block of infection.



3. What types of abnormalities are evident on MRI but not apparent on computed tomography (CT)?


Intrinsic spinal cord pathology such as syringomyelia and multiple sclerosis plaques are uniquely observable by MRI.



4. How is MRI performed?


MRI is carried out by subjecting patients to a sequence of radiofrequency (RF) pulses while they are inside a strong, fixed magnetic field. Images are then created by using various combinations of these RF pulses known as pulse sequences to map out various differing energy-releasing characteristics of tissues.

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Jun 14, 2016 | Posted by in PAIN MEDICINE | Comments Off on Neuroimaging in the Patient with Pain

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