RC 1211 - Reporting the degenerative lumbar spine
1. To become familiar with the different nomenclatures in degenerative disc disease and their anatomic substrates.
2. To learn how to differentiate between the different types of disc disease.
3. To appreciate how the different types of degenerative disc diseases determine the therapeutic approach.
For the clinical management of degenerative spine lesions, the radiologist is of major importance for the discrimination of normal ageing and probable relevant imaging findings. A systematic review will include key anatomic and radiologic features in disc pathology. Standardized disc nomenclature (version 2.0) is mandatory and its key imaging characteristics are showed. Emphasis is placed on pain generators and clear-cut imaging findings such as neural compression. Elusive relationship among other imaging findings and symptoms are also explained. Overall, challenges and pitfalls will be reviewed for the management of potentially relevant lesions using MRI on the background of symptoms relevance. Hints are provided to increase reproducibility and consistency of radiological reports and what clinicians need in our report.
1. To become familiar with the anatomy of the facet joints and the posterior elements.
2. To understand the pathophysiological principle underlying the degenerative changes of these structures.
3. To appreciate the effect of these changes on the therapeutic approach.
Many radiologists reading imaging studies of the spine performed in patients with low back pain (LBP), neck pain, and radicular symptoms tend to focus on the anterior part of the spine, and more specifically on the intervertebral disc. They are often unaware that the posterior elements (facet joints, pedicles, spinal ligaments, spinous processes, etc.). may also be a source of pain. Moreover, radiologists are faced with the low specificity of the morphological abnormalities found on plain film radiography, computed tomography (CT) and magnetic resonance (MR) imaging which are also a frequent finding in the general - often asymptomatic - population. Conversely, the source of LBP (and neck pain) may remain unrecognized unless more dedicated MR imaging sequences such as fat-suppressed (FS) T2-weighted images (e.g. short-tau inversion recovery (STIR)) and FS contrast-enhanced (CE) T1-weighted images are added to the standard spinal MR imaging protocol. These FS-sequences are more sensitive in demonstrating bone marrow oedema, soft tissue inflammation, and hypervascularity that are often associated with degenerative changes of the posterior elements, e.g. facet joint osteoarthritis, synovitis, neural arch intervertebral or spinous process neoarthrosis, etc. Also nuclear medicine techniques such as single-photon emission computed tomography (SPECT), SPECT/CT, etc. are additional imaging techniques that may correctly identify the source of the pain.
1. To understand the legal value of a report.
2. To demonstrate how detailed a report should be.
3. To understand the importance of a clinical information and the relevance of assessing previous examinations.
Following a degenerative spine diagnosis, many issues can be successfully treated with various conservative treatments. These options do not work for every patient, some will need surgical pain relief. Variability in radiologists' reporting styles and recommendations for spinal studies can lead to confusion among clinicians and may contribute to inconsistent patient care. Reporting spine studies requires a systematic approach. The report on MRI of the spine should have following elements: perispinal tissue, bones, disks, spinal canal, facet joints, spinal cord and cauda equina. Adequate techniques and sequences are mandatory for optimal evaluation of spinal structures. In this lecture, the recommendations to improve documentation and reporting of spine MRI will be discussed.