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
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Cervical spine MRI
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Equipment : 1- cervical spine coil . 2- Immobilization pads 3- Ear plugs Pt 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)
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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
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Cervical spine MRI

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

Cervical spine MRI
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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 .
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Cervical spine MRI
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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 C6-7 Fig. 2. Axial images reveal a bilobed (double) focal protrusion at C5-6 Fig 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
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Axial sequence : In case of tumor or soft tissue diseases plot as block not disks.

Cervical spine MRI
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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
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In case of MS also should give contrast .

Cervical spine MRI
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In traumatic patient STIR sequence should be applied .

T- Spine MRI
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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 .
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T- Spine MRI
Standard protocol : € Sagittal T1 € Sagittal T2 € Axial not performed usually except in case of disks.
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T- Spine MRI
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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 .
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Lumbar spine MRI
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Indications :
Disc prolapse with nerve or cord compression. Discitis . Failed back syndrome (chronic back and/or leg pain that occurs after back (spinal) surgery)

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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 )
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L ² Spine MRI
Standard protocol : € Localizer € Sagittal T1 € Sagittal T2 € Axial T1 € Axial T2
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L ² Spine MRI
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Sagittal : Plot on coronal 4 mm thickness 20% gap 2 sat slab

L ² Spine MRI
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Axial : Plot on sagittal . Usually only last three segment 3-4 mm thickness .

L ² Spine MRI

T2 axial

T2 sagittal

L- spine MRI

T1 images

L ² 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 .
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L ² Spine MRI

Total spine

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