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Visualizing intervertebral disc herniation with calcium-suppressed CT images

Case Study
Philips CT Clinical Science Philips Healthcare • USA

Clinical history

This 75-year-old male patient with history of multiple intervertebral disc herniation lesions presented with acute low back pain and was referred to MRI. Among other findings, MRI showed disc herniation at the level of L2-L3. Eigthteen weeks later, CT was performed to plan surgery for decompression of multi-segmental spinal stenosis.

 

Visualization of intervertebral disc pathologies such as disc herniation is limited in conventional CT imaging, making MRI the modality of choice as it is more accurate and sensitive in the diagnosis of soft tissue differentiation.1,2 Calcium Suppression (CaSupp) images may help a clinician to better visualize those pathologies by improving delineation to adjacent bony structures, such as neural foramen.

 

In this case review study, a clinical advantage of the CaSupp image type is demonstrated. Calcium suppression helped the clinician in improved visualization of intervertebral disc herniation. The spectral images were compared to their conventional CT counterparts. MRI images of same region are also included as reference.

Image scan parameters

  • 120 kV
  • Helical CT
  • 1 mm slice thickness
  • 0.98 pitch
  • 0.5 second rotation time
  • Filter B with standard resolution
  • 28.5 mGy CTDIvol
Figure A Sagittal (T2) MRI image shows  L2-L3 disc herniation (arrow)Figure B Sagittal conventional CT image  indicates bone abnormality at the level  of L2-L3 with limited information regarding  disc herniation extent (arrow)Figure C CaSupp reveals disc herniation (arrow) which can be correlated with the MRI image
Figure A
Figure B
Figure C
Sagittal (T2) MRI image shows L2-L3 disc herniation (arrow)
Sagittal conventional CT image indicates bone abnormality at the level of L2-L3 with limited information regarding disc herniation extent (arrow)
CaSupp reveals disc herniation (arrow) which can be correlated with the MRI image

Clinical significance

Visualization of intervertebral disc herniation is limited in conventional CT imaging and usually performed using MRI. The illustrated example shows that calcium-suppressed imaging using IQon Spectral CT provides additional information to the clinician that may help in better assessment of intervertebral disc herniation.

 

Results from case studies are not predictive of results in other cases. Results in other cases may vary.

 

References

  1. Lurie JD, et al. Reliability of Magnetic Resonance Imaging Readings for Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial (SPORT). NIH-PA Author Manuscript, Spine (Phila Pa 1976). 2008 April 20;33(9):991–998. doi:10.1097/BRS.0b013e31816c8379
  2. Nadja A, Farshad-Amacker, et al. MR imaging of degenerative disc disease. European Journal of Radiology 84 (2015);1768–1776.


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Nov 14, 2017

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Case Study
IQon Spectral CT
back pain, Body, calcium suppression, lesion, lumbar spine, Musculoskeletal, spectral CT, stenosis
 

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