Conventional and advanced imaging evaluation of spine

Spine is an important and complex anatomical and functional structure of the human body encompassing the spinal cord and small spinal nerves innervating the entire torso and the extremities. Spine is affected by multiple pathologies ranging from fractures with complex orientations, inflammatory etiology, degenerative disease, neoplasms and others. Diagnosis of such wide variety of pathologies requires advanced imaging that aids in an accurate characterization. Imaging of the spine has evolved over time from plain radiographs and myelography to CT and MRI. Subsequently multiple advances in MRI including neurography, DWI, DTI, and CSF flow study, etc. have led to high resolution and high contrast imaging of spinal pathology as well as assessment of subtle changes in physiology like change in dynamics of CSF flow. Optimal utilization of these modalities is based on good clinical evaluation and clear understanding of the role of various imaging modalities and the information they provide. New advances on the horizon include fast 3D imaging, bone marrow evaluation with dual energy CT, PET-MRI, and research methods, such as arterial spin labeling. This chapter intends to provide the reader a clear understanding of the role of various imaging modalities, their indications and optimal use in the current clinical spine practice.