MRI of Cervical Spine and Neck Presentation
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Questions and Answers

When evaluating spinal cord ischemia, what type of MRI sequence is recommended?

  • Axial FLAIR
  • Sagittal T2-weighted
  • Axial T1-weighted
  • Sagittal DWI (correct)

    • What is the purpose of performing MR-perfusion in patients with neck tumors?

  • To determine the presence of metastases
  • To evaluate the tumor's vascularization (correct)
  • To identify the origin of the tumor
  • To assess the size of the tumor

    • Which anatomical structure is NOT located within the neck?

  • Muscles
  • Blood vessels
  • Thoracic cage (correct)
  • Cartilages

    • What is the patient position during a neck MRI?

    <p>Supine, head first (D)</p> Signup and view all the answers

    What should the patient do during the neck MRI to minimize artifacts?

    <p>Minimise swallowing (D)</p> Signup and view all the answers

    Why is it important to scan inferiorly to below the aortic arch when vocal cord paralysis is suspected?

    <p>The vagus nerve controls the vocal cords and extends below the aortic arch. (A)</p> Signup and view all the answers

    Which of the following is NOT an indication for a cervical spine MRI?

    <p>Generalized body pain (A)</p> Signup and view all the answers

    What is the purpose of the intervertebral discs in the cervical spine?

    <p>To facilitate flexibility of movement, cushion the bones from shock, and assist in maintaining alignment (C)</p> Signup and view all the answers

    What is the purpose of placing the scout slice sagittal localizer for coronal slices?

    <p>To demonstrate the extension of disease lateral to the larynx (C)</p> Signup and view all the answers

    What is the function of the ligamentum flava?

    <p>Connecting the laminae of each of the vertebral bodies from C2 to S1 (D)</p> Signup and view all the answers

    What is the recommended patient position for a cervical spine MRI?

    <p>Supine, head first (C)</p> Signup and view all the answers

    What is the role of contrast media in cervical spine MRI?

    <p>To improve the clarity of soft tissues, such as the spinal cord and discs (D)</p> Signup and view all the answers

    Which of the following is a common reason for performing a cervical spine MRI?

    <p>Suspected spinal epidural hematoma (C)</p> Signup and view all the answers

    What type of contrast agent is typically used in cervical spine MRI?

    <p>Gadolinium (B)</p> Signup and view all the answers

    What is the primary structure that is being imaged in a cervical spine MRI?

    <p>The cervical spine (A)</p> Signup and view all the answers

    What is the purpose of obtaining a sagittal image in a cervical spine MRI?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of these is NOT included in the coverage of a sagittal localizer for obtaining axial slices?

    <p>Intervertebral foramina on each side (B)</p> Signup and view all the answers

    What is the primary reason for obtaining coronal slices in a cervical spine MRI?

    <p>To identify space-occupying lesions within the spinal canal (D)</p> Signup and view all the answers

    What is the typical angle used for obtaining sagittal oblique slices in a cervical spine MRI?

    <p>45° (A)</p> Signup and view all the answers

    Why are bilateral scans sometimes performed separately for sagittal oblique slices?

    <p>To ensure that all nerve roots and foramina are adequately covered (D)</p> Signup and view all the answers

    Which slice orientation is used to achieve visualization of the transverse processes on each side?

    <p>Coronal (C)</p> Signup and view all the answers

    What is the primary purpose of obtaining a coronal localizer in a cervical spine MRI?

    <p>To ensure proper positioning of the patient for the sagittal slices (B)</p> Signup and view all the answers

    What is the major difference between sagittal and axial slices in a cervical spine MRI?

    <p>Sagittal slices are used to view the spinal cord, while axial slices are used to view the vertebral bodies (A)</p> Signup and view all the answers

    Flashcards

    MRI of Cervical Spine

    A set of MRI sequences for assessing the cervical spine.

    Degenerative Disc Disease

    A condition involving disc herniation and radiculopathy, causing pain and nerve issues.

    Spinal Trauma

    Injuries to the spine, including fractures and hematoma.

    Inflammation in Spinal Conditions

    Autoimmune diseases like multiple sclerosis affecting the spine.

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    Spinal Infection

    Infections such as vertebral osteomyelitis in the spine.

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    Anatomy of the Spinal Cord

    The spinal cord exits the skull and runs through the vertebral column.

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    Intervertebral Discs

    Cushions between vertebrae that provide flexibility and shock absorption.

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    Nuchal Ligament

    A ligament extending from the occiput to the seventh cervical vertebra.

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    Sagittal Image Positioning

    Positioning C1 on a sagittal image for counting vertebrae during MRI localization.

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    Coronal Localizer Purpose

    To obtain sagittal slices aligned parallel to the spinal cord for cervical spine MRI.

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    Sagittal Slices Uses

    Demonstrate vertebral alignment, bony integrity, herniated discs, and lesions.

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    Sagittal Localizer for Axial Slice

    Aligns perpendicular to the cervical cord to obtain axial slices.

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    Axial Slices Functions

    Used to display herniated discs and paravertebral extensions.

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    Coronal Slices Uses

    Demonstrate space-occupying lesions from craniocervical junction to thoracic vertebra.

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    Sagittal Oblique Slices

    Slices taken perpendicular to nerve roots in the cervical spine exiting the canal.

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    Coverage Areas

    Coverage from craniocervical junction to thoracic vertebra is vital for MRI.

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    Cervical spinal anatomy

    The symmetrical area between the base of the skull and thoracic cage with bones, muscles, and vessels.

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    Sagittal DWI MRI

    An MRI sequence used to evaluate spinal cord ischemia in the cervical spine.

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    MR-perfusion

    An MRI technique assessing tumors for their vascularization levels.

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    Indications for neck MRI

    Conditions like carcinoma of the larynx, benign lesions, or branchial cleft cysts requiring MRI.

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    Patient positioning for neck MRI

    The patient should be in a supine position with the head first to optimize image quality.

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    Vagus nerve importance

    The vagus nerve extends below the aortic arch and controls the vocal cords; assess if paralysis is suspected.

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    Scout slice placement

    Placement for sagittal and axial slices that guide proper anatomic coverage during MRI.

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    Sagittal vs. coronal slices

    Sagittal slices are anterior to posterior, while coronal slices visualize lateral disease extension.

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    Study Notes

    MRI of Cervical Spine and Neck

    • The presentation is about MRI of the cervical spine and neck.
    • The presenter is Dr. Hayder Jasim Taher, PhD of Medical Imaging.
    • The presentation will cover patient preparation, precautions, contrast media (positive and negative relaxation agents, Gadolinium), anatomical overview and MRI procedure for cervical spine and neck.

    MRI of Cervical Spine: Outline

    • Patient preparation and safety
    • Precautions
    • Contrast media
      • Positive relaxation agents (T1 agents)
      • Negative relaxation agents (T2 agents)
      • Gadolinium

    Anatomical Overview (Cervical Spine)

    • The spinal cord exits the cranium via the foramen magnum.
    • Nerves branch off the spinal cord between each vertebra, beginning with the first cervical nerve root.
    • Intervertebral discs cushion the vertebrae, facilitate movement, and maintain alignment.
    • Anterior and posterior longitudinal ligaments attach to the vertebral bodies.
    • Ligamentum flavum connects the laminae of the vertebral bodies from C2 to S1.
    • Intertransverse and interspinous ligaments connect the transverse and spinous processes of the vertebrae, respectively.
    • The nuchal ligament extends from the occiput to the spinous process of the seventh cervical vertebra.
    • Vertebral arteries course through the transverse foramina of the sixth to first cervical vertebra

    MRI Cervical Spine Protocol

    • The protocol encompasses a set of MRI sequences for routine assessment.

    Indications for Cervical Spine MRI

    • Degenerative disc disease: Disc herniation, radiculopathy, spinal canal stenosis
    • Spinal Trauma: Suspected C.S fractures, spinal epidural hematoma
    • Spinal Tumors: Spinal tumors, vertebral metastasis
    • Inflammation and Autoimmune Conditions: Multiple sclerosis, inflammatory arthritis
    • Spinal Infections: Vertebral osteomyelitis
    • Spinal Vascular Malformation
    • Spinal Cord Infarction
    • Congenital Spinal Malformation
    • Suspected complications of spinal surgery
    • Follow-up of findings on other examinations

    MRI Procedure for Cervical Spine

    • Patient Position: Patient supine, head first, coil placed on the table and plugged in. The superior coil end is placed over the base of the skull to include C1. (FIG. 2)

    • Scout Slice Placement: Coronal localizer to obtain sagittal slices. Alignment: Parallel to the long axis of the spinal cord.

      • Coverage: Craniocervical junction to second thoracic vertebra.
      • Lateral to medial: Vertebral pedicles on each side. C. Posterior to anterior: Spinous processes to prevertebral tissues.

    • Sagital Slices: Demonstrates vertebral alignment, bony integrity, endplate disruptions and herniated discs

      • 1-Vertebral alignment. 2-Bony integrity and end plate disruption. 3-Herniated disc. 4- Space occupying lesions within the spinal canal and spinal canal stenosis.

    • Axial Slices: Sagital localizer to obtain axial slices. Alignment: Perpendicular to the long axis of the cervical cord.

      • Coverage: Pedicle of the third cervical vertebra to the pedicle of the first thoracic vertebra. Post trauma, scans should commence at the base of the skull. Lateral to medial: Intervertebral foramina on each side. and Posterior to anterior: Spinous processes to prevertebral tissues.
      • Demonstrates herniated discs and paravertabral extensions

    • Coronal Slices: Sagittal localizer to obtain coronal slices. Alignment: Parallel to the long axis of the spinal cord.

      • Coverage: Craniocervical junction to the second thoracic vertebra. Lateral to medial: Transverse processes on each side.. Posterior to anterior: Entire vertebral foramen to midway through the vertebral bodies.
      • Demonstrates space occupying lesions within the spinal canal

    • Sagittal Oblique Slices: Axial localizer to obtain sagittal slices. Alignment: Perpendicular to the nerve roots as they exit the cervical canal. An angle of ~45° is expected.

      • Coverage: Craniocervical junction to the first thoracic vertebra, nerves root location and foramina. Lateral to medial: Nerve root origins at the edge of the cervical cord to the lateral aspect of the spinal foramen. Posterior to Anterior: Entire vertebral foramen to midway through the vertebral bodies
      • Demonstrates the severity of foraminal

    MRI Sequences (Cervical Spine)

    • Include specific TR, TE, FA, ETL values and slice thickness for sagittal (T2, T1, STIR), coronal (T1), and axial (T1 post-GAD) sequences.

    Optional Sequences

    • Sagittal (DWI): evaluation of spinal cord ischemia.
    • Sagittal or axial MR-perfusion: evaluation of tumors for their vascularization

    Neck Anatomy

    • Symmetrical region from base of skull to thoracic cage. Composed of bony structures, cartilages, blood vessels, and muscles.

    Indications for Neck MRI (Soft Tissue)

    • Carcinoma of the larynx and hypopharynx
    • Benign lesions of the larynx
    • Second or third branchial cleft cyst

    MRI Procedure for Neck (Soft Tissue)

    • Patient Position: Supine (head first)

    • RF coil setup: Multi-channel neurovascular coil for good signal from base of skull to thoracic inlet.

    • Minimize swallowing during acquisition. Scan inferiorly, below the aortic arch, for vocal cord paralysis imaging.

    • Respiratory discomfort in supine positions: Allow the patient to clear the throat to reduce artifacts.

    • Scout Slice Placement: Sagittal for coronal slices, Anterior to posterior. Anatomical coverage: Anterior from hyoid bone to spinous process, Superior from hard palate to aorta arch.

    • Coronal Slices: Demonstrates Disease extension lateral to the larynx, Metastatic lymph nodes

    • Axial Slices: Sagittal for axial slices, Superior to inferior, Parallel to the hard palate. Anatomical coverage: for vocal cord paralysis scan from hard palate to the arch of the aorta. For neck mass scan from hard palate to sternal notch.

    • Sagittal Oblique Slices: Axial for sagittal slices, True sagittal plane. Includes lesion spread to the base of tongue, disease extension to the neck cartilages.

    MRI Sequences (Neck Soft Tissue)

    • Specific TR, TE, FA, ETL values and slice thickness for Coronal (STIR), axial (T1, T2), and 3D Sagittal (FSPGR) sequences.

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    Related Documents

    MRI of Cervical Spine PDF

    Description

    Explore the intricacies of MRI imaging specifically for the cervical spine and neck in this detailed presentation by Dr. Hayder Jasim Taher. Covering essential topics such as patient preparation, safety precautions, contrast media, and a thorough anatomical overview, this session provides valuable insights for medical imaging professionals.

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