An MRI of the cervical spine is an imaging technique that does not take an X-ray, but uses a magnetic field and radio waves to produce a detailed picture of the cervical spine. The area includes 7 vertebrae of the neck and spine (C1 to C7), intervertebral discs, parts of the spine, nerve roots, ligaments and other soft tissues.

Unlike X-ray and computed tomography (CT) scans, which use radiation, MRI is free of this type of radiation. MRI helps show the soft tissues and is the imaging modality of the spine of choice for a variety of spinal cord issues, disc herniations, spinal cord tumours, infection, trauma to the spine, and any problem associated with the neck from spine wear and tear.

Purpose of MRI Cervical Spine

1. Evaluation of Neck Pain

• Determines the cause of chronic or unexplained neck pain.
• Assists the patient in distinguishing between muscular, disc, degenerative, and nerve conditions.

2. Assessment of Spinal Cord Abnormalities

• Identifies conditions like multiple sclerosis, myelitis, spinal cord compression, and spinal cord tumours.
• Assesses spinal cord injury, edema, or hemorrhage following trauma to the spine.

3. Detection of Disc Disorders

• Takes care of patients with herniated or bulging discs with nerve irritation or compression on the spinal cord.
• Diagnoses discogenic disease and/or associated inflammation.

4. Evaluation of Nerve Root Compression

• Evaluates the foraminal narrowing from osteophytes, disc herniation, or degeneration.
• Estimates the involvement and severity of the nerves.

5. Trauma Assessment

• Can identify epidural hematoma, lateral disc herniation, spinal cord contusion, and edema associated with ligament damage.
• Can detect "hidden" fractures and soft tissue injuries that are not obvious in the X-rays.

6. Evaluation of Tumours and Cysts

• Identifies normal and abnormal tissue inside or around the spinal cord.
• Recognizes arachnoid cysts and synovial cysts.

7. Diagnosis of Inflammatory and Infectious Diseases

• Diagnoses spondylodiscitis, epidural abscesses, vertebral osteomyelitis, and spinal tuberculosis.
• Identifies autoimmune conditions affecting the neck area of the spinal cord.

8. Pre- and Post-Surgical Evaluation

• Helps with the planning of surgical operations, such as decompression or joining bones in the spine.
• Checks on surgery and identifies post-operative complications

Procedure for MRI Cervical Spine

Before the Scan

• A detailed medical and symptom history will be obtained, and you will be asked about any previous surgical and trauma history and neurologic symptoms.
• Let the radiology team know of any medical devices or implants, pacemakers, aneurysm clips, or any other metallic injuries that occurred in the past.
• Remove all metal objects: jewelry, watches, hearing aids, hair ornaments.
• The indication for fasting is not generally mandatory, but is sometimes recommended when intravenous contrast or sedation is used.
• Sedation may be helpful for children or those who have extreme claustrophobia.

During the Scan

• You will not lie down or stand in any position, but will be lying on your back with your head and neck inside a special MRI coil.
• Minimization of movement can be achieved with the use of cushions or immobilization devices.
• Images are taken in several planes, such as sagittal, axial, and occasionally coronal.
• Depending on clinical indications, additional sequences without fat suppression or with contrast enhancement may be acquired.
• The diagnosis normally only takes about 20 to 40 minutes.

After the Scan

• No restriction of activities, unless you were sedated.
• If contrast material is used, good fluids are advised.
• The images will be sent to the radiologist, who will give a detailed report to your referring physician.

MRI Cervical Spine Sequences and Techniques

T1-Weighted Images

• Give anatomical information about the vertebrae and bone marrow in detail.
• Helpful for diagnosing fat lesions and marrow anomalies.

T2-Weighted Images

• Point out CSF and show edema and inflammatory swelling, as well as discuss disc abnormalities.
• Very useful for assessing the spinal cord and the fluid in the body.

STIR (Short Tau Inversion Recovery)

• Reduces the effects of fat cells, thus making the appearance of edema, inflammation, injury to ligaments, infections, and tumours visible.

Gradient Echo Sequences

• Very sensitive to hemorrhage, calcification, and subtle traumatic injury detection.

Contrast-Enhanced T1 Sequences

• Used to assess tumour, infection, inflammation, and post-surgical changes.
• Helps to distinguish recurring disc herniation from post-surgical scar tissue.

Common Conditions Diagnosed with MRI of the Cervical Spine

Cervical Disc Herniation

• A disc herniation is when the disc material protrudes or pushes out and onto the spinal cord or nerve roots.
• May cause pain, numbness, weakness, or cervical radiculopathy in the arm.

Cervical Spondylosis

• A weakening of discs and facet joints leading to pain and stiffness in older age, as discs and facet joints get compressed or irritated.
• It may be accompanied by the development of osteophytes.

Cervical Spinal Stenosis

• A failure of the spinal passage, so that the spinal cord or nerves are compressed.
• Symptoms can include numbness, weakness, imbalance, and difficulty in walking.

Multiple Sclerosis

• On T2-weighted images, it is seen as hyperintense lesions in the cervical spinal cord.
• May cause impaired balance, sensory changes, impaired coordination, and visual dysfunction.

Cervical Myelopathy

• Spinal cord compression resulting in loss of coordination, weakness, balance, and loss of bladder control.
• This is often due to disc herniation, spinal stenosis, tumours, or trauma.

Tumors

• Identifies intramedullary tumours, ependymomas or astrocytomas.
• Diagnosis of tumours outside of the spinal cord, including meningiomas and schwannomas.

Trauma

• Assesses ligament tears, fractures, contusions of the spinal cord and epidural hematomas.
• Assists with surgical and non-surgical treatment options.

Infections

• Identifies discitis, vertebral osteomyelitis, spinal tuberculosis and epidural abscess.

Advantages of MRI Cervical Spine

• Better visibility of the spine, intervertebral discs, ligaments and surrounding soft tissues.
• No re-exposure to ionizing radiation.
• Sufficiently high sensitivity to mild changes in a disease.
• Offers multiplanar imaging for a thorough evaluation.
• Highly sensitive to subtle lesions, inflammation, and nerve compression of the spine.

Limitations and Considerations

Motion Artifacts

• The image quality may be compromised by swallowing, breathing, or movement of the patient.

Metallic Implants

• Some implants may not be compatible with MRI or may cause image distortion.

Claustrophobia

• For some patients, being inside the MRI scanner can be uncomfortable, and they might need sedation.

Contrast Use

• Gadolinium-based contrast agents are safe, and substances that cause allergies are very rare.
• Patients with very serious kidney disease may be asked to have their kidney function assessed.

Patient Preparation Tips

• Put on comfortable, non-metal clothing.
• Let the radiology staff know of any implants, previous surgery, or exposure to metals.
• Be completely still to get the clearest and best photos.
• If you are scheduled for contrast or sedation, follow directions for fasting or taking medication.

Conclusion

MRI Cervical Spine is an important diagnostic technique for investigations of disorders of the upper spinal cord and neck. It provides a better picture of the vertebrae, intervertebral discs, the spinal cord, the nerve roots, and soft tissues. It allows for accurate diagnosis of the causes of disc disease, abnormal spinal cord, tumours, infection, trauma, and degenerative diseases.

MRI Cervical Spine helps in early diagnosis, helps in guidance during the treatment plan, helps in making treatment decisions in surgery, and serves as a means of monitoring results using high-resolution multi-planar imaging and without radiation.