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Standard MRI Pulse Sequences for Evaluating Spinal Lesions

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Here are the standard pulse sequences

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that we use for spinal imaging,

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whether it be for intradural intramedullary

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lesions or for intradural extramedullary lesions.

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Here is our T1-weighed sagittal scan.

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Here, the T2-weighed sagittal scan.

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This is the STIR imaging, which as I described for you,

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causes fat suppression,

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which you see on the T2-weighted scan,

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the fat is bright, but with STIR imaging,

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the fat is dark.

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This is a post-gadolinium T1-weighted scan

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that we also use typically in the sagittal

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plane. In the axial plane,

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we're usually relying on T2-weighted axial

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scans. This is the gradient echo scan,

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which is generally reserved for the cervical

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spine and not used in thoracic

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or lumbar spine imaging.

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And this is an example of the postgad

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axial scan. In this case, we either don't have very

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good fat suppression,

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or it was done without fat suppression.

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What we'd like to do is to nail the high

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signal intensity of the fat here with a

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suppressor pulse and cause it to be dark,

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which allows the background to be even darker.

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And therefore,

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enhancing lesions are going to show up more

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readily in that dark black background.

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So these are the standard pulse sequences that

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are employed for imaging of the spine

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for intradural extramedullary.

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You'll notice that this patient has an intradural

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intramedullary lesion in the spinal cord.

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These are those additional sequences

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that we use in certain occasions.

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What you're seeing on the left are the DWI

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scans, which are used generally for cord

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infarcts and not for intradural extramedullary

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lesions. And on the right hand side,

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we have the MRA of the spine.

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MRA of the spinal cord is very difficult to perform.

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It's usually done in a dynamic mode so that

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you're looking at both the arterial phase,

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as well as the venous phase.

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And then we reconstruct it in a maximum

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intensity projection reconstruction,

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which you're seeing to the right.

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So these are, again, infrequently used,

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but in that certain occasion where you're

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looking for a vascular malformation of the

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spinal canal, you will employ the MRA dynamic technique.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Neuroradiology

Neoplastic

Musculoskeletal (MSK)

MRI

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