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How to Read a Cervical MRI?

Published in Cervical Spine Imaging 5 mins read

Reading a cervical MRI requires a systematic approach and a thorough understanding of spinal anatomy to identify abnormalities and diagnose conditions affecting the neck. While a definitive interpretation should always be done by a qualified radiologist, here's a general overview of how to approach reading a cervical MRI:

1. Familiarize Yourself with Normal Anatomy

Before you can identify pathology, you need to understand the normal anatomy of the cervical spine on MRI. This includes:

  • Vertebrae: The bony building blocks of the spine (C1-C7). Pay attention to their alignment, shape, and signal intensity (brightness) on different sequences.
  • Intervertebral Discs: The cushions between the vertebrae. Look at their height, signal intensity, and any signs of herniation or degeneration.
  • Spinal Cord: The central nervous system structure running through the spinal canal. Evaluate its size, shape, and signal intensity.
  • Nerve Roots: Branches of the spinal cord that exit the spinal canal through the intervertebral foramina. Look for compression or impingement.
  • Ligaments: Tough bands of tissue that connect the vertebrae and provide stability. Examples include the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), ligamentum flavum, and interspinous ligaments.
  • Muscles: The muscles surrounding the cervical spine.
  • Vasculature: Vertebral arteries travel along the cervical spine.

2. Understand the Different MRI Sequences

Different MRI sequences highlight different tissues and pathologies. Common sequences used for cervical spine imaging include:

  • T1-weighted images: Excellent for visualizing anatomy. Fat appears bright, and water appears dark.
  • T2-weighted images: Fluid (water) appears bright. Good for detecting edema, inflammation, and disc hydration.
  • STIR (Short Tau Inversion Recovery): Suppresses fat signal and is highly sensitive to fluid, making it useful for detecting bone marrow edema, fractures, and inflammation.
  • Gradient Echo (GRE) or T2* (T2 star): Sensitive to blood products and calcification. Useful for identifying hemorrhage or certain types of disc herniations.
  • Post-Gadolinium Images (T1-weighted with contrast): Gadolinium is a contrast agent that enhances areas of inflammation, infection, or tumors.

3. Systematic Approach to Reading the MRI

Follow a consistent approach to avoid missing important findings. Here’s a suggested method:

a. Review the Patient Information

  • Patient age and gender
  • Clinical history and symptoms
  • Relevant past medical history (trauma, surgery, etc.)

b. Evaluate the Alignment

  • Check the overall alignment of the cervical vertebrae. Look for any signs of:
    • Spondylolisthesis: Forward slippage of one vertebra over another.
    • Subluxation: Partial dislocation of a vertebra.
    • Scoliosis: Lateral curvature of the spine.

c. Assess the Vertebral Bodies

  • Evaluate each vertebral body for:
    • Fractures: Look for disruptions in the bony cortex or bone marrow edema on STIR images.
    • Degenerative Changes: Osteophytes (bone spurs) and endplate changes (Modic changes).
    • Tumors: Abnormal signal intensity or masses.
    • Infection: Destruction of the vertebral body and disc space (discitis/osteomyelitis).

d. Examine the Intervertebral Discs

  • Evaluate the height and signal intensity of each disc. Note any:
    • Disc Height Loss: A sign of degeneration. (As noted in the reference video, loss of disc height is common as we age.)
    • Disc Bulges: Generalized extension of the disc beyond the vertebral body margins.
    • Disc Herniations: Focal protrusion of disc material beyond the vertebral body margins. Note the location (central, paracentral, foraminal) and size of the herniation. Check for spinal cord or nerve root compression.
    • Annular Tears: Tears in the outer layer of the disc.

e. Evaluate the Spinal Canal and Neural Foramina

  • Assess the spinal canal diameter and the size of the neural foramina (the openings where nerve roots exit). Look for:
    • Spinal Stenosis: Narrowing of the spinal canal, which can compress the spinal cord.
    • Foraminal Stenosis: Narrowing of the neural foramina, which can compress nerve roots.

f. Examine the Spinal Cord

  • Evaluate the spinal cord for:
    • Signal Changes: Abnormal signal intensity may indicate myelopathy (spinal cord damage), inflammation, or tumors.
    • Compression: Look for compression of the spinal cord by disc herniations, bone spurs, or other structures.
    • Size and Shape: Note any atrophy (shrinkage) or swelling of the spinal cord.

g. Assess the Soft Tissues

  • Evaluate the surrounding soft tissues for:
    • Muscle Atrophy: Wasting away of muscles.
    • Inflammation: Edema or swelling.
    • Masses: Tumors or other abnormal growths.
    • Ligamentous Injury: Tears or disruptions of the ligaments.

4. Formulate a Differential Diagnosis

Based on your findings, develop a list of possible diagnoses. Consider the patient's clinical presentation and correlate the imaging findings with their symptoms.

5. Consult with a Radiologist

It is crucial to consult with a qualified radiologist for a final interpretation of the cervical MRI. Radiologists have specialized training and experience in interpreting medical images. They can provide an accurate diagnosis and recommendations for further management.

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