Cervical Spine - MRI Planning

Wednesday, September 28, 2016

Cervical Spine MRI are done to rule out these common indications:
  • Cervical myelopathy
  • Cervical radiculopathy
  • Cervical cord compression and trauma
  • Assessment of extend of spinal infection or tumor
  • Diagnostic of Chiari malformation and cervical syrinx. Total extend of syrinx must be determined. Whole spine MR imaging may be necessary.
  • MS plaques within the cord.

Equipment use in Cervical MRI

  • Posterior cervical neck coil or volume neck coil or multi-coil array spinal coil.
  • Immobilization pads and traps.
  • Pe gating leads is required
  • Ear plugs

Patient Position – Cervial MRI

On the examination couch the patient is supine with neck coil placed around under the cervical region. Coils are made to fit the back of the head and neck so that the patient is automatically centered to the coil. If a flat coil is used, place a supporting pads under the shoulder to flattens the curve of the cervical spine so that it will become close to proximity coil. This coil should extend from the base of the skull to the sternoclavicular joints in order to include the whole cervical spine.
Longitudinal alignment is at the midline of the patient and horizontal light passes to the level of hyoid bone. The hyoid bone can be usually locate and felt above the thyroid cartilage or the adams apple. Put foam pads and retention straps on patient heads for immobilization. Attach Pe gating leads if required.

Suggested Protocol – Cervical MRI

Sagittal / Coronal SE / FSE T1 or coherent GRE T2

This act as the localizer if three plane localization is unavailable. The Coronal or sagittal planes may be used.

Coronal Localizer

These are medium slices of images and are relatively prescribed to the vertical alignment light, from the posterior aspect of the spinous processes to the anterior border of the vertebral bodies. The area from the base of the skull to the second thoracic vertebral is included in the image. P 20 mm to A 30 mm.

Sagittal Localizer

These are the images from left to right lateral border of the vertebral bodies with medium slices (left 7 mm and right 7 mm) thickness. The image should include the area of the base of skull to the second thoracic vertebral.

Sagittal SE / FSE T1

A thin slice (left 22 mm to Right 22 mm) on either side of the longitudinal aligment light, from the left to the right lateral borders of the cervical vertebral bodies unless paravertebral areas are required. The base of the skull to the second thoracic vertebra should include in the image.
Sagittal SE / FSE T2 or coherent GRE T2
Slice planning is just the same with sagittal T1.

cervical MRI
Sagittal SE T1 weighted midline image through
the cervical spine.

Sagittal SE/FSE T2 or coherent GRE T2*

Slice prescription as for Sagittal T1.

cervical mri
Sagittal FSE T2 weighted midline image through
the cervical cord.

Axial / oblique SE / FSE T1 or T2 / or coherent GRE T2

This is a thin slices and are angled so that they are parallel to the disc space of perpendicular to the lesion under examination. For disc disease, 3 to 4 slices per level usually needed. For larger lesions such as tumor or syrinx, thicker slices covering the lesion and a small area above and below may be necessary.
cervical mri
Axial/oblique coherent GRE T2* weighted
image through the cervical cord.

Additional Sequence - Cervical Spine MRI

Sagittal / axial oblique SE / FSE T1

This sequences use for contrast enhancement for tumor in cervical spine, and this slice planning sequence is just like with Axial / Oblique T2.

Sagittal SE / FSE T2 or STIR

It is an alternative to coherent GRE T2. Slice planning as for sagittal T2.

Sagittal FSE T2 weighted image showing slice
prescription boundaries and orientation for axial imaging of
the cervical cord.
Sagittal coherent GRE T2* weighted image of the
cervical spine showing axial/oblique slice positions
parallel to each disc space.

3D Coherent / Incoherent (Spoiled) GRE T1 / T2

A thin and a few or medium number of slice locations are prescribed through the ROI. If PD or T2* weighting is desired, then a coherent or steady-state sequence is used. If T1 weighted is required an incoherent or spoiled sequence is necessary. These sequence may be acquired in any plane but, if reformatting is required, isotropic datasets must be acquired.

Sagittal SE / FSE T1 or fast incoherent (Spoiled) GRE T1 / PD

The slice prescription as for Sagittal T1, T2 and T2*, except neck in flexion and extension to correlate the potential relevance of spondylotic changes to signs and symptoms.

3D balanced gradient echo (BGRE)

The contrast characteristic of a BGRE sequence provide for high signal from CSF ( high T2 and T1 ratio) and thus produces images with high contrast between CSF and nerve roots. It is important to remember that because these images are not true T2 weighted, subtle cord lesions such as MS plaques may not be seen. As such they are typically utilized when imaging a patient for radiculopathy (disk disease) rather than myeliphathy or cord lesions.

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