MRI of Cervical Spine PDF

MRI of cervical spine And neck Dr.Hayder Jasim Taher PhD of Medical Imaging Outline of my presentation Patient preparation and safety. Precautions. Contrast media. A -Positive relaxation agents (T1 agents). B -Negative r...

MRI of cervical spine And neck Dr.Hayder Jasim Taher PhD of Medical Imaging Outline of my presentation Patient preparation and safety. Precautions. Contrast media. A -Positive relaxation agents (T1 agents). B -Negative relaxation agents (T2 agents). Gadolinium.  Anatomical overview Exiting the cranium via the foramen magnum, the spinal cord is contained within the vertebral column. It gives off nerves on each side between each of the bones in the spine, commencing with the first cervical nerve root between the base of the skull and the first cervical vertebra. Intervertebral discs between each vertebra, commencing at the C2/3 level, facilitate flexibility of movement, cushion the bones from shock, and assist in maintaining alignment. Ligaments supporting the spine include the anterior and posterior longitudinal, intimately attached to the bodies of the vertebrae. Connecting the laminae of each of the vertebral bodies from C2 to S1 are the ligamentum flava. The intertransverse and interspinous ligaments connect the transverse processes and spinous processes of the vertebrae, respectively. Finally, the nuchal ligament extends from the occiput to the spinous process of the seventh cervical vertebra. The vertebral arteries course through the transverse foramen of  Anatomical overview (Fig.1) Normal anatomy of cervical spine  MRI of cervical spine MRI of cervical spine: The MRI cervical spine protocol encompasses a set of MRI sequences for the routine assessment of the cervical spine.  Indications of cervical spine MRI 1- Degenerative disc disease which include: - Disc herniation and radiculopathy. - Suspected spinal canal stenosis. 2-Spinal trauma, suspected C.S fractures, spinal epidural hematoma. 3-Spinal tumors or vertebral metastasis. 4-Inflammation and autoimmune conditions which include: - Multiple sclerosis. - Inflammatory arthritis. 5-Spinal infection such as vertebral osteomyelitis.  Indications of cervical spine MRI 6-Spinal vascular malformation. 7-Spinal cord infarction. 8-Congenital spinal malformation. 9-Suspected complications of spinal surgery. 10-Follow up of findings on other examinations.  MRI procedure - Patient position: Place the coil on the magnet table and plug it in. Place patient supine, head first. Rest the head and neck in the coil. Position the superior end of the coil at the base of the skull. This position should include C1 on a sagittal image so that you can count vertebra for localization purpose. Fig.2 patient position (fig.2) (cervical-spine MRI)  MRI procedure Scout slice placement: - 1-Coronal localizer to obtain sagittal slices. - Alignment: Parallel to the long axis of the spinal cord. - Coverage: A-Superior to inferior: Craniocervical junction to second thoracic vertebra. B-Lateral to medial: Vertebral pedicles on each side. C-Posterior to anterior: Spinous processes to prevertebral tissues. - Sagittal slices can be used to demonstrate the following: - 1-Vertebral alignment. 2-Bony integrity and end plate disruption. 3-Herniated disc. 4- Space occupying lesions within the spinal  MRI procedure 2-Sagittal localizer to obtain axial slice -Alignment: Perpendicular to the long axis of the cervical cord. - Coverage: A-Superior to inferior: 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. B-Lateral to medial: Intervertebral foramina on each side. C- Posterior to anterior: Spinous processes to prevertebral tissues. - Axial slices can be used to demonstrate the following: 1-Herniated disc. 2-Paravertebral extension of  MRI procedure 3-Sagittal localizer to obtain coronal slice: -Alignment: Parallel to the long axis of the spinal cord. Some obliquity will most likely be required to achieve this. - Coverage: A-Superior to inferior: Craniocervical junction to the second thoracic vertebra. B- Lateral to medial: Transverse processes on each side. C-Posterior to anterior: Entire vertebral foramen to midway through the vertebral bodies. - Coronal slices can be used to demonstrate the following: 1- Space occupying lesions within the spinal  MRI procedure 4-Axial localizer to obtain sagittal oblique slice: -Alignment: A-Perpendicular to the nerve roots as they exit the cervical canal in the mid cervical spine. An angle of approximately 45° should be expected. B-Verify that the slices will cover the nerve roots and foramina on each side at the superior and inferior cervical spine. C-Bilateral scans may be performed simultaneously or separately. -Coverage: A-Superior to inferior: Craniocervical junction to the first thoracic vertebra. B-Lateral to medial: Nerve root origins at the edge of the cervical cord to the lateral aspect of the spinal foramen. C-Posterior to anterior: Entire vertebral foramen to midway through the vertebral bodies. -Note: Complementary to the axial images, this view MRI Sequences (Cervical spine)  Optional sequences 1- Sagittal (DWI): evaluation of spinal cord ischemia. 2- Sagittal or axial MR-perfusion: evaluation of tumors for their vascularization.  Anatomical overview The anatomy within the neck is generally symmetrical and is described as the region between the base of skull and the bony thoracic cage. It contains multiple bony structures, cartilages, blood vessels, and muscles.  Indications of neck MRI (soft tissue): 1-Carcinoma of the larynx and hypopharynx. 2-Benign lesions of the larynx. 3-Second or third branchial cleft cyst.  MRI procedure (Neck- soft tissue) Patient position: 1 - Patient should be in supine-position (head first). 2 - Set up the coil (multi-channel neurovascular). The RF coil of choice must provide good signal from the base of skull to below the thoracic inlet. 3 - Ask the patient to minimize swallowing during the scanning acquisition to avoid artifacts across the image. Make sure to scan inferiorly to below the aortic arch when vocal cord paralysis is suspected. The vagus nerve that controls the vocal cords extends below the aortic arch. -Other considerations: Patients with diseases of the airways may suffer from respiratory discomfort that may be exacerbated in the supine position. Allowing the patient the opportunity to clear the throat between each pulse sequence may assist in generating  MRI procedure (Neck- soft tissue) Scout slice placement: 1-Sagittal localizer for coronal slice: -SLICE ACQUISITION: Anterior to posterior. - SLICE ALIGNMENT: Parallel to the vertebral bodies. - ANATOMIC COVERAGE: Anterior from hyoid bone to the spinous process, superior from the hard palate to the arch of the aorta. -CORONAL SLICES ARE USED TO DEMONSTRATE THE FOLLOWING CONDITIONS: 1-Disease extension lateral to the larynx.  MRI procedure (Neck- soft tissue) 2-Sagittal localizer for axial slice -SLICE ACQUISITION: Superior to inferior. - SLICE ALIGNMENT: Parallel to hard palate. -ANATOMIC COVERAGE: For vocal cord paralysis scan from hard palate to arch of the aorta. For neck mass scan from hard palate to sternal notch.  MRI procedure (Neck- soft tissue) 3-Axial localizer for sagittal slice -ALIGNMENT: True sagittal plane. - COVERAGE: As for axial plane. - SAGITTAL SLICES ARE USED TO DEMONSTRATE THE FOLLOWING CONDITIONS: 1-Lesion spread to the base of tongue. 2- Disease extension to the neck cartilages. MRI Sequences (Neck-soft tissue) Thank