Coluna: Imagem. Marcelo de Abreu. Mae de Deus Hospital CLINOSON Porto Alegre - Brazil

Transcrição

1 Coluna: Imagem Marcelo de Abreu Mae de Deus Hospital CLINOSON Porto Alegre - Brazil

2 Onde está a dor

3 Dor no sistema Osteoarticular e Coluna Dor Discogênica, subcondral, articular, neuropática Dor por compressão nervosa Dor por inflamação nervosa

4 LOMBALGIA E CITALGIA DESAFIO Normal x Patológico Alterações da Idade Sintomáticos

5 ACHADOS de IMAGEM MARCADORES DE DOR RESSONANCIA UTILIZAÇÃO DE TÉCNICAS COM SATURAÇÂO DE GORDURA BME

6 ACHADOS de IMAGEM MARCADORES DE DOR SÍNDROME FACETÁRIA FRFSE T2 Fat Saturation

7 Alteração Degenerativa CARTILAGEM HIALINA BME

8 STIR T1 FRFSE T2 Fat Saturation

9 Diagnosis of Nerve Injury Historically electrophysiological evaluation has been considered the mainstay of diagnosis. Today, MR Neurography, plays an increasingly important role in the work-up of neuropathies.

10 MR Neurography MR Imaging dedicated to Nerves T2-weighet, Diffusion and DTI Indications in Brachial and Lumbosacral Plexus: Radiculopathies Neuropathies Pos Operative Pain of Unknown Location

11 MR Neurography 1.5 T T2-weighted (STIR SPACE 3D) Disc Protrusion 3T MRN Isotropic STIR 0.9mm MRN STIR + MIP 10mm + MPR

12 MR Neurography 1.5 T Fat/Water Imaging Fat-Sat FSE IDEAL FSE courtesy of Jonh Carrino HSS NY

13 STIR SPACE 3D Courtesy Dr Chabra, Dallas.

14 MR Neurography Physics Endoneural Fluid Protein =(long T2) Nerve damage fluid endoneural

15 MR Neurography Diffusion weighted PSIF axial com MPR e MIP (10mm) 2.5mm or 1mm axial (3-5 min) Radiology 2008

16 Increase in Diffusion Neural Edema Permeability Rupture of do endoneurium with pressure increase Desmielination, isquemia, Walleriana deg Nerv: Normal Nervo: Compressed Water molecules movement alteration

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18 Whole-Body Magnetic Resonance Neurography Yamashita T, M.D. Tokai University Kanagawa, Japan Kwee T, M.D. University Utrecht, Utrecht, the Netherlands NEJM 2010 healthy 23-year-old male volunteer 73-year-old man with chronic inflammatory demyelinating polyneuropathy (CIDP)

19 CLINOSON- POA, presented Singapure 2012 NeuroAsia Congress

20 MR Neurography RADIOLOGY REPORT Compare Nerves (sides) Nerve Signal Nerve Thickness Ganglia Thickness

21 MR Neurography RADIOLOGY REPORT

22 STIR 3D SPACE MIP 10mm G5 G5 G6 G7 G6 G7

23 DIFFUSION PSIF MIP 10mm C6 C6 C7 C7

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25 MRN Protocolo 1.5T Herniated disc foraminal, not found at routine MR. Onda F (tibial) App Dermatomes : App Store

26 Case 1. Right Foraminal herniated disc L3-L4. MRN PSIF (+ & -)

27 Case 2. Radiculo L3, HIZ, 47ª

28 Case 3. Pos Op: left radiculopathy. MRN STIR SPACE 3D: denervation paravertebral, left L5 RAD MRN STIR

29 Case 4.Left Radiculopathy for 3 months, getting better. MRN: normal MRN Difusão PSIF

30 Case 4.Left Radiculopathy for 3 months, getting better. MRN: normal

31 Case 5: 38y F, 1 week of pain and cauda equina syndrome.

32 Case 6. Diabetic Neuropathy, M 60a DM2, Right leg weakness with + EMG test. ACianfoni et al. Neurology 2009

33 Case 7: 48y F, right radiculopathy

34 Case 8: 52 y F, pos op, left S1 Radiculopathy Contrast Gad

35 Case 9: 64y M, Pos Op: Fibrosis around S1, left thigh paresthesias and pain. MRN Sacro STIR

36 Case 10: 61y M. Left leg pain. Supect of Tarlov symptomatic cyst. Normal MRN

37 Case 11. Pos Op: M 51ª, Lumbar Pain. L5 fibrosis

38 Case 12. Posterior Thigh Pain. Normal Lumbar MR

39 Case 14: 30ª F, plastic surgery. Pain in both legs and sensibility loss.

40 Case 15: left arm pain, paresthesia 3º, 4º e 5º fingers, long airplane flight from Dubai to São Paulo. Neuropraxia (pos traumatic plexitis) C5 C6 C7 T1.

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43 Neurografia Indicação: Radiculopatia Exames duvidosos em Coluna Pedido Médico Ressonância CLS, Qadril, CC Ressonância Plexo Cervical Ressonância Plexo Lombosacral (neurgrafia)

44 Neurografia por RM del Plexo Braquial y Lumbosacro Marcelo de Abreu Mae de Deus Hospital - CLINOSON Porto Alegre - Brazil

45 Last Case: Left Neck Pain and Radiculopathy Normal Spine MRI, ENMG: doubt? Diagnóstico MRN Parsonage Tuner Syndrome: Inflamatory Plexopathy Nervo ulnar (cutâneo braquial interno) Luigeti et al. MR Neurography. Internal Medicine 2013

46 Caso Clínico: Radiculo aguda L5 bilateral por estenose foraminal em L5-S1 por lisese e dicopatia.

47 Caso Clínco: feminina de 50 anos com lombociatalgia à esquerda, apresentando discopatia. A sequência coronal T2 demonstra importante espessamento e hiperintesidade das raizes nervosas, relacionadas a Neuropatia Hereditária, CIDP ou outra Polineuropatia

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