Spine CT

What is CT Scanning of the Spine?

Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical imaging test. Like traditional x-rays, it produces multiple images or pictures of the inside of the body.

A CT scan generates images that can be reformatted in multiple planes. It can even generate three-dimensional images. Your doctor can review these images on a computer monitor, print them on film or via a 3D printer, or transfer them to a CD or DVD.

CT images of internal organs, bones, soft tissue, and blood vessels provide greater detail than traditional x-rays. This is especially true for soft tissues and blood vessels.

Using CT, the bony structure of the spine vertebrae is clearly and accurately shown, as are intervertebral disks and, to some degree, the spinal cord soft tissues.

What are some common uses of the procedure?

Perhaps, the most frequent use of spinal CT is to detect—or to rule out—spinal column damage in patients who have been injured.

CT scanning of the spine is also performed to:

• assess spine fractures due to injury.
• evaluate the spine before and after surgery.
• help diagnose spinal pain. One of the most common causes of spinal pain that may be diagnosed by CT is a herniated intervertebral disk. Occasionally, this diagnosis is made using CT myelography.
• accurately measure bone density in the spine and predict whether vertebral fractures are likely to occur in patients who are at risk of osteoporosis.
• assess for congenital anomalies of the spine or scoliosis.
• detect various types of tumors in the vertebral column, including those that have spread there from another area of the body. Some tumors that arise elsewhere are first identified by finding deposits of malignant cells (metastases) in the vertebrae; prostate cancer is an example.
• guide diagnostic procedures such as the biopsy of a suspicious area to detect cancer, or the removal of fluid from a localized infection (abscess).

In patients with narrowing (stenosis) of the spine canal, vertebral fracture, infection or degenerative disease such as arthritis, CT of the spine may provide important information when performed alone or in addition to magnetic resonance imaging (MRI).

How should I prepare?

Wear comfortable, loose-fitting clothing to your exam. You may need to change into a gown for the procedure.

Metal objects, including jewelry, eyeglasses, dentures, and hairpins, may affect the CT images. Leave them at home or remove them prior to your exam. Some CT exams will require you to remove hearing aids and removable dental work. Women will need to remove bras containing metal underwire. You may need to remove any piercings, if possible.

Your doctor may instruct you to not eat or drink anything for a few hours before your exam if it will use contrast material. Tell your doctor about all medications you are taking and if you have any allergies. If you have a known allergy to contrast material, your doctor may prescribe medications (usually a steroid) to reduce the risk of an allergic reaction. To avoid unnecessary delays, contact your doctor well before the date of your exam.

Also tell your doctor about any recent illnesses or other medical conditions and whether you have a history of heart disease, asthma, diabetes, kidney disease, or thyroid problems. Any of these conditions may increase the risk of an adverse effect.

Women should always inform their physician and the CT technologist if there is any possibility that they may be pregnant. See the CT Safety During Pregnancy page for more information.

What does the equipment look like?

The CT scanner is typically a large, donut-shaped machine with a short tunnel in the center. You will lie on a narrow table that slides in and out of this short tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is in a separate control room. This is where the technologist operates the scanner and monitors your exam in direct visual contact. The technologist will be able to hear and talk to you using a speaker and microphone.

How does the procedure work?

In many ways, a CT scan works like other x-ray exams. Different body parts absorb x-rays in different amounts. This difference allows the doctor to distinguish body parts from one another on an x-ray or CT image.

A conventional x-ray exam directs a small amount of radiation through the body part under examination. A special electronic image recording plate captures the image. Bones appear white on the x-ray. Soft tissue, such as the heart or liver, shows up in shades of gray. Air appears black.

With CT scanning, several x-ray beams and electronic x-ray detectors rotate around you. These measure the amount of radiation being absorbed throughout your body. Sometimes, the exam table will move during the scan. A special computer program processes this large volume of data to create two-dimensional cross-sectional images of your body. The system displays the images on a computer monitor. CT imaging is sometimes compared to looking into a loaf of bread by cutting the loaf into thin slices. When the computer software reassembles the image slices, the result is a very detailed multidimensional view of the body's interior.

Nearly all CT scanners can obtain multiple slices in a single rotation. These multi-slice (multidetector) CT scanners obtain thinner slices in less time. This results in more detail.

Some CT exams use a contrast material to enhance visibility in the body area under examination.

How is the procedure performed?

The technologist begins by positioning you on the CT exam table, usually lying flat on your back. They may use straps and pillows to help you maintain the correct position and remain still during the exam.

If a contrast material is used, it will be injected through an intravenous line (IV) into an arm vein during the procedure. A scan of the spine may also be done after injecting contrast material into the spinal canal (usually well below the bottom of the spinal cord) during a lumbar puncture test, also known as a myelogram. This will help to locate areas of inflammation or nerve compression or detect tumors.

Next, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine for the actual CT scan. Depending on the type of CT scan, the machine may make several passes.

The technologist may ask you to hold your breath during the scanning. Any motion, including breathing and body movements, can lead to artifacts on the images. This loss of image quality can resemble the blurring seen on a photograph taken of a moving object.

When the exam is complete, the technologist will ask you to wait until they verify that the images are of high enough quality for accurate interpretation by the radiologist.

The entire exam is usually completed within 30 minutes.

What will I experience during and after the procedure?

CT exams are generally painless, fast, and easy. Multidetector CT reduces the amount of time that the patient needs to lie still.

Though the scan is painless, you may have some discomfort from remaining still for several minutes or from placement of an IV. If you have a hard time staying still, are very nervous, anxious, or in pain, you may find a CT exam stressful. The technologist or nurse, under the direction of a doctor, may offer you some medication to help you tolerate the CT exam.

If the exam uses iodinated contrast material, your doctor will screen you for chronic or acute kidney disease. The doctor may administer contrast material intravenously (by vein), so you will feel a pin prick when the nurse inserts the needle into your vein. You may feel warm or flushed as the contrast is injected. You also may have a metallic taste in your mouth. This will pass. You may feel a need to urinate. However, these are only side effects of the contrast injection, and they subside quickly.

When you enter the CT scanner, you may see special light lines projected onto your body. These lines help ensure that you are in the correct position on the exam table. With modern CT scanners, you may hear slight buzzing, clicking and whirring sounds. These occur as the CT scanner's internal parts, not usually visible to you, revolve around you during the imaging process.

You will be alone in the exam room during the CT scan, unless there are special circumstances. For example, sometimes a parent wearing a lead shield may stay in the room with their child. However, the technologist will always be able to see, hear and speak with you through a built-in intercom system.

With pediatric patients, a parent may be allowed in the room but may need to wear a lead apron to minimize radiation exposure.

After a CT exam, the technologist will remove your intravenous line. They will cover the tiny hole made by the needle with a small dressing. You can return to your normal activities immediately.

Who interprets the results and how do I get them?

A radiologist, a doctor specially trained to supervise and interpret radiology exams, will analyze the images. The radiologist will send an official report to the doctor who ordered the exam.

You may need a follow-up exam. If so, your doctor will explain why. Sometimes a follow-up exam further evaluates a potential issue with more views or a special imaging technique. It may also see if there has been any change in an issue over time. Follow-up exams are often the best way to see if treatment is working or if a problem needs attention.

What are the benefits vs. risks?

Benefits

• Spinal CT scanning is a rapid procedure and offers an accurate evaluation of bone and most soft tissues. Using the latest equipment, the spine may be displayed in multiple planes and three-dimensional imaging may be reconstructed.
• CT scanning is painless, noninvasive, and accurate.
• A major advantage of CT is its ability to image bone, soft tissue, and blood vessels all at the same time.
• Unlike conventional x-rays, CT scanning provides very detailed images of many types of tissue as well as the lungs, bones, and blood vessels.
• CT exams are fast and simple. In emergency cases, they can reveal internal injuries and bleeding quickly enough to help save lives.
• CT has been shown to be a cost-effective imaging tool for a wide range of clinical problems.
• CT is less sensitive to patient movement than MRI.
• Unlike MRI, an implanted medical device of any kind will not prevent you from having a CT scan.
• CT imaging provides real-time imaging, making it a good tool for guiding needle biopsies and needle aspirations. This is particularly true of procedures involving the lungs, abdomen, pelvis, and bones.
• A diagnosis via CT scan may eliminate the need for exploratory surgery and surgical biopsy.
• No radiation remains in a patient's body after a CT exam.
• The x-rays used for CT scanning should have no immediate side effects.

Risks

• There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk involved with CT scanning.
• The radiation dose for this procedure varies. See the Radiation Dose page for more information.
• Women should always tell their doctor and x-ray or CT technologist if there is any chance they are pregnant. See the Radiation Safety page for more information about pregnancy and x-rays.
• Doctors do not generally recommend CT scanning for pregnant women unless medically necessary because of potential risk to the unborn baby.
• IV contrast manufacturers indicate mothers should not breastfeed their babies for 24-48 hours after contrast material is given. However, the most recent American College of Radiology (ACR) Manual on Contrast Media reports that studies show the amount of contrast absorbed by the infant during breastfeeding is extremely low. For further information please consult the ACR Manual on Contrast Media and its references.
• The risk of serious allergic reaction to contrast materials that contain iodine is extremely low, and radiology departments are well-equipped to deal with them. If you had prior allergic reactions to CT contrast materials, it is important to inform your doctor in advance. Medications may be prescribed prior to the CT scan to minimize the risk of allergic reactions.

What are the limitations of CT Scanning of the Spine?

A person who is very large may not fit into the opening of a conventional CT scanner. Or, they may be over the weight limit—usually 450 pounds—for the moving table.

Spinal CT does not consistently show enough detail to properly assess the spinal cord. If a patient had a previous surgery to place hardware such as rods or a screw, the quality of the CT images may be degraded due to the hardware. MRI may be more suitable than CT for demonstrating injured ligaments, the status of the intervertebral disks, spinal cord abnormalities and hematomas in the area of the spine.