Spine MRI

Cervical spine MRI Indications : Cervical myelopathy.(compression

on the cervical spinal cord from either a disc herniation or cervical spine stenosis.)

Cervical cord compression or trauma.

Assessment of extent of spinal infection or tumor .

MS plaques within the cord

Cervical spine MRI Equipment :1- cervical spine coil .2- Immobilization pads3- Ear plugsPt position : Supine with neck placed within neck coil .

Alignment light should be at midline , the horizontal at level of hyoid bone ( above thyroid cartilage )

Ask the patient to keep swallowing and movement to minimum .

Cervical spine MRI

Standard protocol : Localizer 3 planes or(sagittal and

coronal ) Sagittal T1 Sagittal T2 Axial T2 * ( FLASH)

Cervical spine MRI

Sagittal : Plot on coronal localizer . Slice thickness 3-4 mm Gap : 20 % ( 0.6 -0.8 mm) Sat. slab : coronal anterior to the

vertebra * duplicate image

Cervical spine MRI

Cervical spine MRI Sagittal T1 TR : 450-600 TE : 12-25

Cervical spine MRI Sagittal T2 TR : 2500-4000 TE : 100-120

Cervical spine MRI

Cervical spine MRI Axial T2 * Plot on sagittal image parallel to disk

space normaly from C3 to C7 3 mm slice thickness Multiple NEX FLASH sequence(incoherent gradient echo ) used because is less sensitive to

motion as SE .

Cervical spine MRI T2 * TR : 850 TE : 26 Flip angle : 30

Cervical spine MRI

Fig 1. Sagittal MRI of the cervical spine demonstrating evidence of disc herniation at C5-6 and C6-7Fig. 2. Axial images reveal a bilobed (double) focal protrusion at C5-6Fig 3. Axial images reveal a central focal protrusion at C6-7

Disc herniation

Disc herniation classification. A: Normal disc anatomy demonstrating nucleus pulposus (NP) and annular margin (AM). B: Disc protrusion, with NP penetrating asymmetrically through annular fibers but confined within the AM. C: Disc extrusion with NP extending beyond the AM. D: Disc sequestration, with nuclear fragment separated from extruded disc.

Cervical spine MRI Axial sequence : In case of tumor

or soft tissue diseases plot as block not disks.

Cervical spine MRI If suspect tumor : Sagittal T2 Sagittal T1 Axial T1 block Adminstration of

contrast Axial T1 block Sagittal T1

T2

Cervical spine MRI

Sagittal T1 T1 Gad +

Cervical spine MRI In case of

MS also should give contrast .

Cervical spine MRI In traumatic

patient STIR sequence should be applied .

T- Spine MRI Indications : Thoracic disk disease. Thoracic cord

compression . Visualizalion of MS

plaque in the thoracic cord .

Thoracic cord tumor . Equipment : Posterior spine coil .

T- Spine MRI

Pt position : supine , head first , the coil extend

from the top of shoulder to the lower costal margin . The longitudinal alignment in the midline the horizontal at centre of coil level of T4 .

T- Spine MRI

Standard protocol : Sagittal T1 Sagittal T2 Axial not performed usually except

in case of disks.

T- Spine MRI Sagittal sequence

: 4mm thickness Plot on coronal

scout.

T- Spine MRI

T2 Sagittal T1 sagittal

T- Spine MRI

Contrast media should be adminstrated in case of tumor .

STIR sequence is used for traumatic patient .

Lumbar spine MRI Indications : Disc prolapse with nerve or cord

compression. Discitis . Failed back syndrome (chronic back

and/or leg pain that occurs after back (spinal) surgery)

Equipment : Posterior spine coil . Foam pads to elevate knee. Ear plugs .

Lumbar spine MRI

Position : Supine , head first ,elevate knees

for comfort and flatten lumbar spine curve ,

The coil extend from xiphisternum to the bottom of the sacrum .

The longitudinal alignment at midline , the horizontal at L3 ( lower costal margin )

L – Spine MRI

Standard protocol : Localizer Sagittal T1 Sagittal T2 Axial T1 Axial T2

L – Spine MRI Sagittal : Plot on coronal 4 mm thickness 20% gap 2 sat slab

L – Spine MRI Axial : Plot on sagittal . Usually only last

three segment 3-4 mm thickness

.

L – Spine MRI

T2 axial T2 sagittal

L- spine MRI

T1 images

L – Spine MRI

Contrast media is used in case of tumors and after lumbar disk surgery to differentiate adhesions from new disks .

Axial and sagittal T1 performed after CM

STIR for traumatic patient .

L – Spine MRI

Total spine

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