Thoracic and Lumbosacral Spine Anatomy.

We review anatomy of the thoracic, lumbar, and sacral spine. Knowledge of normal anatomy is vital when reviewing imaging of the spine because it allows for the detection of abnormal findings. We emphasize the normal appearance of the thoracic and lumbosacral spine on imaging, focusing on the most common imaging techniques of computed tomography and magnetic resonance imaging, as well as highlighting a few less common and emerging imaging techniques that can evaluate the spine.

A Case of Spinal Infectious Osteomyelitis Versus Gout: Advanced Imaging with Dual Energy CT.

A 67-year-old male presented to the hospital for lower back pain and left lower extremity radiculopathy. Although the patient was afebrile and white blood cell count was normal, MRI was concerning for discitis/osteomyelitis at L4-L5. Subsequently, the patient developed a right knee joint effusion and underwent an arthrocentesis that was notable for the presence of urate crystals. A systemic urate crystal arthropathy was proposed as a potential etiology for the patient's back pain and radiculopathy. Dual energy CT of the lumbar spine was performed, a technique which determines material composition by comparing the photon attenuation of the substance from two different x-ray energy levels. Results revealed the presence of monosodium urate crystals in the intervertebral discs. This technique is proposed as a noninvasive way to evaluate for gout in atypical locations or those difficult to sample and may replace an invasive intervertebral disc/endplate aspiration and/or biopsy. Dual energy CT should be considered in patients with elevated serum uric acid and concern for spinal involvement of gout.

Utility of routine follow-up imaging in patients with small paraflacine and/or paratentorial hemorrhages.

OBJECTIVE: Imaging follow-up for acute intracranial hemorrhage has followed the same protocols despite differences in clinical progression and outcome associated with bleed in different compartments. We evaluated isolated, small parafalcine and paratentorial subdural hemorrhages to determine the necessity of routine imaging follow up. METHODS: We conducted a retrospective review of all patients presenting to the Emergency Department who were found to have an isolated parafalcine and/or paratentorial subdural hemorrhage, and obtained follow up imaging over the course of 3 years. Subsequent imaging was reviewed to assess for changes in hemorrhage size and the average number of studies performed; clinical data was reviewed for changes in patient status and any intervention if performed. RESULTS: 95 patients were identified with isolated parafalcine and/or paratentorial hemorrhage that were evaluated with multiple follow-up imaging studies. The average initial subdural hemorrhage thickness was 3.5 mm, with all smaller than 1 cm. The average number of subsequent imaging studies performed was 2.7. All patients received follow up imaging despite remaining neurologically stable. 96 % of the patients had stable to decreased size off hemorrhage on follow up exams. The remaining 4% had a slight increase on the second imaging study but, stabilized without any intervention. Anticoagulation use had no correlation with increase on subsequent imaging. CONCLUSION: Small isolated parafalcine and/or paratentorial hemorrhage in a neurologically stable patient and absence of anticoagulation does not require scheduled routine follow-up imaging.

The impact of DaTscan on the diagnosis and management of movement disorders: A retrospective study.

BACKGROUND: The diagnosis of Parkinson's disease remains a challenge in patients who have abnormal symptoms or show a lack of response to medication. The imaging technique, DaTscan, can be used to visualize dopamine degeneration in the nigro-striatum, which is associated with Parkinsonian Syndrome. We examined the use of the DaTscan in diagnosis, confidence in diagnosis, and clinical management. METHODS: Physicians of 125 patients were contacted to fill out a brief survey about changes in diagnosis, confidence of diagnosis, and clinical management after assessment with the DaTscan. RESULTS: There was an overall increase in confidence of diagnosis with the results of the DaTscan. Physicians also stated that the DaTscan impacted their diagnosis in 68% of the patients, as well as an impact in the clinical management of 58% of the patients. CONCLUSION: The DaTsan can be used as a tool to help diagnose Parkinsonian Syndrome in patients with unclear symptoms.