FLAIR hyperintensity in the subarachnoid space: Main differentials.

The fluid-attenuated inversion recovery (FLAIR) sequence forms part of the vast majority of current diagnostic protocols for brain MRI. This sequence enables the suppression of the signal from cerebrospinal fluid, facilitating the detection of disease involving the subarachnoid space. The causes of hyperintensity in the arachnoid space in this sequence can be divided into two main categories: hyperintensity due to disease and hyperintensity due to artifacts. Hyperintensity due to tumors, inflammation, vascular disease, or hypercellularity of the cerebrospinal fluid or hematic contents is well known. However, numerous other non-pathological conditions, mainly due to artifacts, that are also associated with this finding are a potential source of diagnostic errors.

Hiperintensidad en secuencia FLAIR del LCR en el espacio subaracnoideo: diagnósticos diferenciales / FLAIR hyperintensity in the subarachnoid space: Main Differentials

La secuencia fluid attenuated inversion recovery (FLAIR) forma parte hoy en día de la gran mayoría de protocolos diagnósticos de RM cerebral. Esta secuencia de inversión-recuperación permite una supresión de la señal del líquido cefalorraquídeo, lo que facilita la detección de enfermedad que afecta al espacio subaracnoideo. Las causas de hiperintensidad del líquido cefalorraquídeo en esta secuencia pueden subdividirse en 2grandes grupos, las patológicas y las debidas a artefactos. Son bien conocidas la etiología tumoral, la inflamatoria, la vascular o las debidas a hipercelularidad del líquido cefalorraquídeo o a ocupación por contenido hemático. Sin embargo, existen numerosas condiciones no patológicas, principalmente debidas a artefactos, que se relacionan con este hallazgo constituyendo una potencial fuente de errores diagnósticos.(AU)

The fluid-attenuated inversion recovery (FLAIR) sequence forms part of the vast majority of current diagnostic protocols for brain MRI. This sequence enables the suppression of the signal from cerebrospinal fluid, facilitating the detection of disease involving the subarachnoid space. The causes of hyperintensity in the arachnoid space in this sequence can be divided into two main categories: hyperintensity due to disease and hyperintensity due to artifacts. Hyperintensity due to tumors, inflammation, vascular disease, or hypercellularity of the cerebrospinal fluid or hematic contents is well known. However, numerous other non-pathological conditions, mainly due to artifacts, that are also associated with this finding are a potential source of diagnostic errors.(AU)

Enfoque clínico-radiológico de la mielopatía no traumática / Clinical-radiological approach to nontraumatic myelopathy

Las enfermedades de la médula espinal tienen con frecuencia consecuencias devastadoras y su estudio radiológico es indispensable para su diagnóstico. La técnica de imagen fundamental para su valoración es la resonancia magnética espinal y el enfoque diagnóstico debe basarse en el contexto clínico, el tiempo de evolución y los hallazgos radiológicos, por lo que es necesario en algunos casos la ampliación del estudio a la región cerebral. El primer paso en el algoritmo diagnóstico debe ser excluir la compresión medular antes de valorar otras causas de mielopatía, entre las que se incluyen múltiples etiologías. Este artículo incluye una amplia revisión de las diferentes patologías que pueden producir mielopatías, sus manifestaciones radiológicas, diagnósticos diferenciales y algoritmos diagnósticos. Un adecuado enfoque por parte del radiólogo repercutirá en un mejor manejo y pronóstico de estos pacientes

Diseases of the spinal cord often have devastating consequences and imaging studies are indispensable for their diagnosis. The fundamental imaging technique to evaluate these diseases is magnetic resonance imaging of the spine. The diagnostic approach must be based on the clinical context, the time elapsed since the onset of symptoms and signs, and the imaging findings; for this reason, it sometimes necessary to broaden the study to include the brain. The first step in the diagnostic algorithm is to rule out spinal cord compression before evaluating other causes of myelopathy, which sometimes has multiple causes. This paper includes a broad review of the different diseases that can cause myelopathy, their imaging manifestations, their differential diagnoses, and diagnostic algorithms. Using an appropriate radiological approach will result in better management and prognosis of these patients

Clinical-radiological approach to nontraumatic myelopathy. / Enfoque clínico-radiológico de la mielopatía no traumática.

Diseases of the spinal cord often have devastating consequences and imaging studies are indispensable for their diagnosis. The fundamental imaging technique to evaluate these diseases is magnetic resonance imaging of the spine. The diagnostic approach must be based on the clinical context, the time elapsed since the onset of symptoms and signs, and the imaging findings; for this reason, it sometimes necessary to broaden the study to include the brain. The first step in the diagnostic algorithm is to rule out spinal cord compression before evaluating other causes of myelopathy, which sometimes has multiple causes. This paper includes a broad review of the different diseases that can cause myelopathy, their imaging manifestations, their differential diagnoses, and diagnostic algorithms. Using an appropriate radiological approach will result in better management and prognosis of these patients.

Evaluación de la columna lumbar posquirúrgica / Evaluation of the postoperative lumbar spine

Dada la gran prevalencia del dolor lumbar, la cirugía de columna es una intervención cada vez más frecuente. Existen múltiples procedimientos quirúrgicos disponibles, de los que la laminectomía y discectomía son las intervenciones más frecuentes. En un 10-40% de los pacientes intervenidos, el dolor lumbar que ocasionó la intervención puede recurrir o no solucionarse completamente, lo que se incluye dentro del síndrome de cirugía fallida de columna. Hay múltiples causas que pueden ocasionar este síndrome, aunque frecuentemente es de etiología multifactorial y no deben confundirse con los hallazgos normales en columnas postoperadas. La decisión de la técnica de imagen a realizar dependerá del tipo de cirugía, la utilización de material ortopédico metálico y la sospecha clínica. El conocimiento de las ventajas y limitaciones de las distintas técnicas de imagen disponibles es esencial para la óptima valoración de estos pacientes, especialmente tras cirugía con instrumentación donde serán necesarios ajustes técnicos para minimizar el artefacto producido por estos materiales (AU)

Given the prevalence of low back pain, surgical interventions on the lumbar spine are becoming more common. Among the many surgical procedures available for these interventions, the most common are laminectomy and discectomy. In 10 to 40% of patients who undergo surgical interventions on the lumbar spine, low back pain is not completely alleviated or it recurs, and these cases fall into the category of «failed back surgery syndrome». This syndrome can have many different causes and multiple factors are often involved. It is important not to confuse the normal postoperative findings with those specific to failed back surgery syndrome. Deciding which imaging technique to use will depend on the type of surgical intervention, whether metallic orthopedic material was used, and the clinical suspicion. It is essential to know the advantages and limitations of the available imaging techniques to ensure the optimal evaluation of these patients, especially after interventions carried out with instrumentation to minimize the artifacts due to these materia (AU)

Evaluation of the postoperative lumbar spine.

Given the prevalence of low back pain, surgical interventions on the lumbar spine are becoming more common. Among the many surgical procedures available for these interventions, the most common are laminectomy and discectomy. In 10 to 40% of patients who undergo surgical interventions on the lumbar spine, low back pain is not completely alleviated or it recurs, and these cases fall into the category of « failed back surgery syndrome ¼. This syndrome can have many different causes and multiple factors are often involved. It is important not to confuse the normal postoperative findings with those specific to failed back surgery syndrome. Deciding which imaging technique to use will depend on the type of surgical intervention, whether metallic orthopedic material was used, and the clinical suspicion. It is essential to know the advantages and limitations of the available imaging techniques to ensure the optimal evaluation of these patients, especially after interventions carried out with instrumentation to minimize the artifacts due to these materials.