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Abstract Imaging of the spinal lesions is a routine practice in most radiological departments, the diversity of spinal lesions and imaging techniques available necessitates better understanding of the values and limitations of each imaging modality, in order to deliver the most effective one to answer the patient’s problem. Plain X-ray still plays an important role in the initial evaluation of spinal lesions, it is the simplest, cheapest method of investigation, yet in a small percentage of cases, it can provide the final diagnosis. It should be emphasized that in most cases a normal plain X¬ray does not exclude an underlying condition because a significant amount of bone loss should be present before pathological changes become visible in plain X-ray. Computed Tomography (CT) is a very effective way of examination of the spine especially with the use of spiral CT technique. It is the best modality available today for detection of bony pathology. The use of conventional myelography alone as a method of investigation of the spine is rapidly declining due to its invasive nature and the limited data acquired from it compared with other new techniques; however CT-myelography still has its advantages in certain clinical situations. Primary metrizamide CT (CT following instillation of a small amount of metrizamide intrathecally) should be used as an alternative to CT¬myelography because of the decreased incidence of side-effects with the low dose required (I ml to 5 ml of isotonic contrast) Imaging is easier also: contrast density after full-dose myelography is occasionally high enough to cause computer artifact if an extended scale is not employed. Scintigraphy is a highly sensitive but non specific tool for examination of the entire skeleton; it plays an important role in the management of metastatic diseases. The use of Gallium-67 citrate in addition to Technetium 99m can increase specificity in the detection of inflammatory processes. Spinal angiography is an invasive procedure which has its role in the preoperative evaluation of vascular lesions of the spine (e.g. AVM) or certain hyper vascular lesions such as haemangioblastomas. It can be utilized as a treatment option when embolization of these hyper vascular lesions is attempted. Ultra sonography plays a minimal role in the routine work up of spinal lesions; it can be utilized in the management of congenital spinal lesions to better evaluate the content of congenital back masses. Magnetic resonance imaging (MRI) is a great technical innovation that is acquiring a fundamental role in the evaluation of spinal lesions. MRI is a procedure with inherent soft tissue capabilities that is non invasive and without known biological hazards. With the recent technical advances in this field and the development of newer pulse sequences, MRI is now considered the imaging modality of choice for the management. |