Posts tagged ‘Thoracic’

May 21, 2014

MRI Case Study: “Thoracic Cord Syrinx” or “Some new vocab words for today”

SAG t2 8Here is an example of an MRI of the thoracic spine. The image on the left is taken as if the body were being sliced from head to toe (sagittal image) and the image below is as if the body were being sliced across the middle like a loaf of bread (axial image).

 

The image to the left shows the vertebral bodies as blocks and the spinous processes back behind the spinal canal as obliquely oriented blades. The spinal canal on both contains the spinal cord which is mostly black surrounded by the normal cerebrospinal fluid which is white. The thoracic cord normally has a little bit of a bulge as it ends in the upper lumbar spine, seen on the sagittal image towards the bottom.

 

This patient presented for evaluation of mid-back pain. On the left side sagittal image, the cord has an area of white running through it centrally from top to bottom. This is seen as the central spot of white within the normally dark cord on the axial image. The signal of this area matches the signal of the cerebrospinal fluid surrounding the cord.

 

This area of white is one example of cord pathology that might be picked up on an MRI. This is known as a syrinx (or syringohydromyelia – how’s that for a long name!) and is an abnormal buildup of fluid in the central canal of the cord. Over time, this fluid buildup can enlarge and start to affect the nerves running through the cord, sometimes resulting in symptoms like muscle weakness.

 

Remember, most patients with back pain will find their symptoms resolve within 4 weeks. If symptoms do not improve or are accompanied by other changes like muscle weakness, evaluation by your doctor is warranted.

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!AX t2

May 14, 2014

What’s Up with Your Neck? (and just below…)

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Have pain in your neck or upper back? You are not alone! While less common than low back pain, pain in the neck is a common complaint leading to doctor’s office visits. Pain in the upper back is somewhat less common, but we will include it in our discussion for completeness.

 

In a recent post we talked about imaging of the lumbar spine, the lower portion of the spine which sits behind your belly.  Much of the imaging for the rest of the spine is similar to what is done for the lumbar region.

 

The cervical spine (coming from the Latin word for neck) is sometimes referred to as the C spine. It consists of the first seven vertebrae (from the skull) and the cartilage discs between them, in addition to adjacent ligaments and muscles. A lot of motion (up,down, around!) occurs in this part of the spine during the day, so this is a common spot for symptoms of overuse or muscle strain to occur.

 

Patients with cervical spine problems may have pain in the neck with or without symptoms in the upper arms/shoulders – this can be pain or can be nerve type symptoms like numbness or tingling. How far the symptoms go down your arm can help indicate the level of involvement in the cervical spine.

 

The T Spine is the thoracic spine consisting of the 12 vertebral bodies, discs, adjacent muscles and ligaments at chest level. There is less movement of the spine at this level, so symptoms here are less common. Symptoms of thoracic spine problems may include pain in the upper back, shoulders, arms, or to the sides of the chest. Nerve symptoms like numbness, tingling or weakness may also be present.

 

As in the lumbar spine, there are a lot of age-related changes involving the discs and/or the adjacent bones; these may or may not be related to the patient’s symptoms. Imaging of the cervical and thoracic spine is generally performed after careful history and physical examination, and may be delayed to see if a trial of conservative treatment improves symptoms. Imaging immediately may be warranted if there are serious symptoms such as major trauma, weight loss, or nerve symptoms, particularly weakness of the arms or legs.

The spectrum of problems in the cervical and thoracic spine is similar to that in the lumbar spine and can include disc displacement, fractures, and muscle strain. Less common causes of neck and upper back symptoms include disease in the spinal cord itself, spinal cord tumors and things like multiple sclerosis. Note that the spinal cord ends at approximately the upper lumbar level; therefore, these problems do not directly affect the lumbar spine.

 

Imaging of the cervical and thoracic spine is similar to that for the lumbar spine. X-ray, CT and MRI can all be used to diagnose problems.Plain films or x-rays may be the best starting point as they can show alignment and fractures. X-rays can also show any narrowing in the spaces between the vertebra indicating disc disease. A CT shows bones and adjacent tissues and is the test of choice if we are concerned about fractures. CT can see the cord and nerve roots if we do it after a myelogram (more commonly done with C spine than with the T spine). Last, an MRI can show the spinal cord, nerve roots and discs and how they relate.

 

Ultimately, imaging of the neck and upper spine may be helpful to determine the proper course of action to get you on the road to your best possible health!

(Image credit: Illu vertebral column via Wikimedia Commons Copyright Public Domain)


Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

May 23, 2013

CT: A Better Way to Scan for Lung Cancer

In an article published by the New England Journal of Medicine on May 22nd, the National Lung Screening Trial had good news to report: Through the use of low-dose computed tomography, doctors were able to recognize lung cancer earlier and more often than through traditional chest x-ray.

The initial phases of the study, published in 2011, showed a 20% reduction in mortality among patients diagnosed with lung cancer. This is credited to the fact that twice as many early stage cancers were discovered using low-dose computed tomography (LDCT) than chest x-ray (CXR).

This most recent finding of the study specifically shows that LDCT discovers lung cancers more often than CXR. This is very good news for those at high risk for lung cancer – earlier and improved detection means expediting the process of healing and hopefully recovery.

The American Association for Thoracic Surgery recommends annual LDCT for specific high-risk groups, specifically North Americans meeting any of the following:

  • aged 55 to 79 years old with a history of 30 pack-years* of smoking

  • long-term lung cancer survivors up through the age of 79

  • those with a 20 pack-year history, starting at age 50 if there is an “additional cumulative risk of developing cancer of 5% or greater over the following 5 years.”

Doctor’s note: Please don’t smoke. Avoiding cancer is even better than discovering it early.

648px-X-ray_chest_cancer

Source: X-ray(Chest)Cancer.jpg: unknown
derivative work: Anassagora (talk)
Copyright: Public Domain

*A “pack-year” number is derived from multiplying the number of packs smoked per day times the number of years smoked – so 30 pack years could be smoking 1 pack a day for 30 years, or 2 packs a day for 15 years.