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NORMAL AREAS OF SPINAL ENHANCEMENT ON MRI

Normal areas of Enhancement in the Spine

Before we can assess for abnormal enhancement, its important to know which areas and structures normally enhance post contrast on MRI.

 

FOUR AREAS OF NORMAL ENHANCEMENT

In the spine there are 4 regions that normally enhance

  1. Epidural Venous Plexus: Anterior more than posterior
  2. Basivertebral Veins
  3. Dorsal Nerve root ganglion
  4. Veins over the surface of the conus and cord.

mri spine enhancement normal radiology education asia

Image Above:

  1. Anterior “epidural” venous plexus ( Blue Arrows) can be quite prominent but are in a characteristic location on either side of midline.¬†
  2. Strictly speaking, anatomically, these veins are in the a space within two layers in the Posterior Longitudinal Ligament and not in the epidural space (. However on MRI the split layers of the PLL cannot be seen and they appear to lie in the anterior epidural space. (see below in ” Read More” for reference)
  3. Apparent enhancement in the posterior vertebral body ( orange arrows) is normal enhancement of the Basivertebral Veins

mri spine enhancement normal dorsal nerve root ganglion radiology education asiaImage Above: Normal enhancement of the Dorsal Nerve root Ganglion ( blue arrows). Characteristic location in the foramen, bilateral and symmetrical.

 

mri spine enhancement normal anterior posterior spinal veins radiology education asiaImage Above:

  1. The anterior and posterior spinal veins run over the anterior and posterior margin of the cord.
  2. In the lumbar spine they are equally prominent but in the cervical spine its usually the anterior vein that is seen.
  3. You can differentiate them from letomeningeal enhancement by the expected location and also their serpigenous appearance. Leptomeningeal metastases in this region will have a more nodular appearance.
  4. These veins are not seen in the thoracic cord.

mri spine enhancement normal epidural enhancement radiology education asiaImage Above:

  1. Normal Epidural Fat ( blue arrow) does not enhance and should fat saturate ( orange arrow).
  2. Note normal posterior epidural vein enhancement ( purple arrows) which is usually less prominent than the anterior epidural venous plexus.

 

Anatomy

mri spine veins normal epidural enhancement radiology education asia

Image Above: Nice diagram  illustrating the various veins around the spinal canal and cord. From Intradural Spinal Vein Enlargement in Craniospinal Hypotension, M. Todd Burtis et al

 

Read More:
Intradural Spinal Vein Enlargement in Craniospinal Hypotension, M. Todd Burtis et al

 

 


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February 27, 2019