MRI Essentials for the Spine Specialist 1st Edition
MRI Essentials for the Spine Specialist 1st Edition
by A. Jay Khanna (Editor)
[This book] would be a worthy addition to the collection of any neurosurgical spine specialist, in either practice or training. The systematic approach to analyzing anMRI study, in addition to the clear and easily understood theory behind why the images appear as they do, makes this a great addition to the neurosurgical tome. Congratulations to the author for the excellent work.” — Neurosurgery-online.com MRI Essentials for the Spine Specialist is a comprehensive textbook that details the complex MRI anatomy of the spine and the spectrum of pathological findings in patients with spinal disorders. Covering basic concepts such as the physics of MRI and normal MRI anatomy of the spine as well as advanced MRI techniques, this book will help clinicians develop a systematic approach to the accurate interpretation of spine MRI studies.
Region-specific and concept-specific chapters systematically covering what the spine specialist must master All chapters written by spine surgeons, interventional pain specialists, and radiologists, specifically for clinicians More than 450 MR images and 80 instructive illustrations to help readers visualize and clarify their understanding of the concepts presented
Practical and focused review of how other imaging modalities correlate with and complement MRI Common Clinical Questions with answers and detailed explanations in each chapter
This text will be an important resource for spine surgeons, interventional and non-interventional pain specialists, interventional radiologists, neurologists, sports medicine specialists, and any other physicians or allied health professionals with an interest in the management of patients with spinal disorders. It is also an excellent reference for diagnostic radiologists who interpret spine MRI studies and would like to gain a better understanding of the associated clinical aspects.
Given the large number of publications, journals, and textbooks available in the area of spinal disorders, it is refreshing to see a practical, focused text on a topic that is universally critical to all practitioners who care for patients with spinal pathologies. The introduction of MRI technology revolutionized all medical diagnostics, but it arguably is the single most important advancement in the evaluation of spinal pathology. The ability to interpret and relate spinal abnormalities, detected on the MRI study, into the treatment algorithms for our patients is an essential element in the successful clinical treatment of patients with a broad range of spinal pathologies. It is important for any practitioner to be able to accurately interpret an MRI study because, although some findings can be quite subtle, the consequences of making inaccurate interpretations or “missing” significant pathology can have catastrophic effects on the ultimate outcome of our patients. In addition, many studies have shown that the sensitivity of MRI technology and the presence of age-appropriate degenerative changes that occur normally in patients with increasing age should be considered. The ability to detect spinal pathology, put it in the appropriate clinical context, and minimize the treatment of nonrelevant pathology is truly an art form in the
treatment of our patients. The lower success rates of spinal interventions and surgery may arguably be the result, at least in part, of “over-reading” or overemphasizing the significance of some MRI findings. Regardless, the ability to accurately interpret spinal MRI studies is critical, and this textbook is an extremely valuable resource for all spinal practitioners.
MRI for Spine Surgeons and Specialistsis a textbook written by spine surgeons, spine specialists, and radiologists to detail the relatively complex MRI anatomy of the spine and the spectrum of pathological findings in spinal disorders. I congratulate the editor and all the authors of this text for putting forth the core concepts of MRI technology as they relate to the spine, with correlative chapters on anatomic pain generators and MRI findings. The second part of the text is focused on the different anatomic areas of the spine from the occiput to the sacrum. The last portion of the text explores more advanced concepts and special considerations for pediatric patients, tumors, MRI safety, and the correlation of MRI studies with other imaging studies. Taken as a whole, this is a comprehensive compilation of all aspects of the use of MRI for imaging the spine and spinal pathologies.
The editor of this textbook, Dr. Jay Khanna, has great experience in MR imaging and is a passionate educator on this topic. He has created several educational efforts in this specific area and has taught several courses, conducted meetings, and edited other texts on MR imaging. As a noted expert in the field, he has constantly striven to create new resources to help spine surgeons and specialists utilize this technology in order to ultimately help with better care for our patients.I believe this text is a crucial collection of information that all spine practitioners should read and utilize as a resource in the diagnosis and treatment of our patients with spinal disorders. I commend the editor and all the authors for their commitment to this educational endeavor and anticipate that this text will be well received by all spine specialists, both operative and nonoperative.
Although the ability to evaluate MRI studies is critical to the clinical and surgical care of patients with spine pathology, most clinicians learn this skill in an informal fashion, by experience gained throughout their training and in clinical practice. As a result, we may not have (or need) a thorough understanding of the science and physics of MR imaging and the various pulse sequences that are available for obtaining the images. Many of us clinicians prefer to read our patients’ MR imaging studies ourselves rather than rely solely on the “official” radiologist’s report. We learn to make preoperative, intraoperative, and postoperative decisions based on those readings. However, unlike radiologists who are trained to evaluate MRI studies in a systematic fashion, we may be more likely to evaluate the images in a less organized manner and to rely on our anatomic expertise and experience, which may not be the most effective method.
This text, MRI Essentials for the Spine Specialist, will teach the reader how to systematically evaluate and interpret MR imaging studies of the spine. Specialists who may benefit from reading and referencing this book include spine surgeons, interventional and noninterventional pain specialists, interventional radiologists, physiatrists,rheumatologists,neurologists, sports medicine specialists, and any other physicians or allied health professionals who have an interest or expertise in the management of patients with spinal disorders. This book is also an excellent reference for diagnostic radiologists who interpret spine MRI studies and would like to gain a better appreciation of the associated clinical aspects.
Although there are many excellent books that focus on MR imaging of the spine, this one is unique in that it is written by spine surgeons (with both orthopaedic and neurosurgical backgrounds), interventional pain specialists, and radiologists specifically for clinicians. As such, it is clinically oriented and presents the information from a perspective that a spine surgeon or specialist will appreciate.My desire to create this book stems from my interest and background in musculoskeletal imaging and from my recognition of the fact that the ability to accurately evaluate MR imaging studies is critical to the care of patients with spinal pathology. Along these lines, over the last several years, I have helped develop and deliver several courses for spine surgeons in practice and in training that teach them how to systematically evaluate MR imaging studies of the spine. In doing so, I realized that many of the textbooks and other resources on the topic of spine MRI
are written by radiologists and directed toward radiologists and radiologists in training. This perceived void of imaging resources for clinicians who care for patients with spine and other musculoskeletal pathologies led me to compile and edit the predecessor of this book, MRI for Orthopaedic Surgeons, which was also published by Thieme Medical Publishers.
That textbook provided an overview of MR imaging of the entire musculoskeletal system by anatomic region. Given the success of that book and my personal interest in providing a more in-depth evaluation of my primary area of clinical interest, the spine, we decided to create this textbook. Thieme Medical Publishers has graciously allowed me to reuse someof the relevant text, images, and drawings from MRI for Orthopaedic Surgeons, and I have built upon that
content with current theories and practices, contributions authored by acknowledged experts, and additional illustrative material.
The chapters of MRI Essentials for the Spine Specialistare organized into three sections: (1) Core Concepts, (2) Anatomical Regions of the Spine: Spectrum of Disease, and (3) Advanced Concepts and Special Considerations. Each of these three sections, or each chapter, can be read independently, but the textbook is best read in sequential chapter order. In particular, before reading the chapters on individual spinal regions, the clinician should review Chapter 2, “Normal Spine MRI Anatomy,” and Chapter 3, “Common Clinical and Correlative Pain Generators of the Cervical and Lumbosacral Spine.” These two chapters provide a moderately comprehensive evaluation of the key anatomic structures and concepts with which one should be familiar when reviewing an MR imaging study of the occipitocervical, cervical, thoracolumbar, and lumbosacral spine; they also serves as a reference point when evaluating the pathologic images in a region-specific chapter.
This book features two different types of chapters: region-specific and concept-specific. The region-specific chapters (e.g., Chapter 6, “The Cervical Spine,” and Chapter 7, “The Lumbar and Thoracic Spine”) share a common organization, with sections on specialized pulse sequences and protocols, traumatic pathology, degenerative pathology, infectious conditions, and postoperative findings. The concept-specific chapters (e.g., Chapter 10, “Advanced Techniques in Spine MRI”) are organized in a fashion that best suits the individual chapter’s content and the goal xii Preface
Most of the chapters have been authored by spine surgeons, interventional pain specialists, and radiologists. Some, such as the region-specific chapters, have spine surgeons as the primary authors, with radiologists as co-authors for accuracy and clarity from their standpoint. Others (e.g., “Essentials of MRI Physics and Pulse Sequences”) were written solely by radiologists, but the presentation of the material was specifically designed with a clinician audience in mind. The collaboration between clinicians and radiologists that has been used to produce this textbook emulates the optimal relationship between these two groups of physicians in clinical practice.
This book was envisioned to be a practical aid to develop and/or refine the skills needed to effectively and systematically evaluate MR imaging studies of the spine. I hope that it accomplishes this goal for you.A. Jay Khanna, MD, MBAof providing spine surgeons and specialists with the information they need to maximize their proficiency in evaluating and interpreting MR imaging studies.MRI Essentials for the Spine Specialistcontains nearly 450 MR images and approximately 150 artist’s drawings that have been carefully selected and created to help illustrate and teach the essential anatomy and pathology that a spine surgeon, other clinician, or radiologist should be able to recognize and define when evaluating an MRI study of the spine. As such, much of the material can be reviewed effectively by evaluating the images and illustrations along with the associated figure legends. In addition, this book contains a new feature, which is a set of Common Clinical Questions (with answers and explanations) for each chapter. These questions will also allow the reader to review the material efficiently and test his or her comprehension of some of the key concepts from each chapter.†added to figure legend or table title indicates that the figure or table was borrowed from Dr. Khanna’s book, MRI for Orthopaedic Surgeons. xiiiAcknowledgmentsFirst and foremost, I would like to thank the many contributors to this text. They have given generously
of their time and willingly shared their knowledge gained from years of clinical and research experience, which has culminated in the informationpacked pages of this book.Next, a sincere thank you to Kay Conerly, executive editor at Thieme, for inviting me to help create this book under the Thieme banner and for allowing us to follow in the success of our previous book together, MRI for Orthopaedic Surgeons. Thanks, as well, to Judith Tomat at Thieme for her outstanding efforts in bringing this book through the publishing process and helping us navigate our way through the various steps from concept to final product. Thanks, also, to Kenneth Chumbley, production editor, for his meticulous work during the final phase of the book and specifically for helping us solve the puzzle of merging numerous images and illustrations with the text to create a beautiful layout. A very special thank you to Tony Pazos, medical illustrator extraordinaire, for his skill, attention to detail, and willingness to work through many rounds of revisions. Thanks also to Jennifer Pryll for conceptualizing and creating the cover art, which creatively illustrates the intention of this book, which is to focus on the convergence of
the clinical presentation of our patients and the radiographic manifestations of their spinal conditions.Finally, I would like to express my greatest appreciation to Elaine Henze, medical editor for The Johns Hopkins University’s Department of Orthopaedic Surgery. She, with the support of Jenni Weems, has spent countless hours on this project at work and
on her own time during an especially challenging personal year. I thank Elaine for helping me with the multiple rounds of edits and revisions for every chapter, table, image, figure, and legend. Her commitment to accuracy and focus on quality have helped ensure this book is the excellent product you see today.
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