Noncontrast MRI cervical spine search pattern
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- เผยแพร่เมื่อ 25 มิ.ย. 2024
- Magnetic resonance imaging (MRI) of the cervical spine is a very commonly encountered test which can be performed for a variety of indications, including degenerative disease, trauma, demyelinating disease, and metastatic disease. Most of these cases will be done without contrast, as most of the information is there on a non-contrast exam.
This video will walk you through a step-by-step approach to evaluating an MRI of the cervical spine. The optimal approach is to use select sequences to evaluate each part of the study in the following order:
Alignment
Vertebral bodies
Marrow signal
Intervertebral discs
Spinal cord/canal
Soft tissues
Individual levels
Each sequence in the study has strengths at looking at one or more of these things. As we walk through, we'll take a look at how to use each one.
The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with spine diseases.
Check out this video and additional content on www.learnneuroradiology.com
Thank you very much for your videos. I am an internist in Australia and I've learned so much through watching your videos. You are doing a wonderful job.
Great to hear! I'm glad you enjoyed the videos and thanks for stopping in.
Welcome back . Was waiting for this . Many thanks .
Thanks! I have a little bit more spare time now so I'll try to make more.
@@LearnNeuroradiology Thanks a lot.
@@LearnNeuroradiology hi sir im sean i had mri of my neck last march i have a written report and a c d copy could you maybe give me your opinions on my written results...not with signature like im not presenting it or anything i am just really curious you seem very smart and my neck says disc osteophyte complex at c2 c3 DISC osteophyte complex foraminal stenosis moderate hen again c3c4 foraminal stenosis moderate and other then that smhmorls nodes small in superior endplates of c6 and c7 vertabrea bodys and disc heights otherise maintained i can write out the report but that most of it ..narrow developmental spinal canal but no significant spinal stenosis spine enlightenment within normal limits ..i have questions i think you might be able to answer ill pay if i have too haha but hopefully you get this thankyou sir ps love watching your videos
Great video, I learned a lot. What I would like to see is a side by side comparison of normal to abnormal findings.
well done, great job
I learned a lot from it ,many thanks from Jordan
Thank you - Great Video!
Glad you enjoyed it!
Super information about cervical spine
Thanks
Great video. Ty
Thank you too!
Hi , please do a video on how you asses the canal , the foramina , zygohypophyseal joints . Also I am very confused by the uncovertebral joints !!!!! and if possible go through a complex degenerative neck like you did for the lumbar spine . Thank you in advance .
Thank You Very Much Sir
Most welcome
new subbbie can you do a video on reading level by level C spine? showing UVH, infolding ligamentum flavem, SAN, etc
How old was this person you are showing?
Plz make video on atlantoaxial instability & radio-diagnosis 🙏
Thanks for your videos. It helps me a lot and I'm going to teach my students by following your tips.
Thanks! Always great to be sharing knowledge!
👌🌹Alignment 02:36 03:15
🌹Vertebra Body 04:23
🌹Marrow Signal 05:35
🌹Disc 07:36
多以Sagittal T2做評估
🌹Cord/Canal 09:01:
是以Sagittal /Axial T2 的view做評估。
🌹各別椎節的閱片重點則是 把Sagittal 及Axial 的T2 View放同畫面做綜判。 14:26. 15:05
Thanks for the markers. I try to put chapters in most of the newer videos to make it easier.
In this link u see short video ,of cervical spine with some sections of thoracic spine ,i see herniated disc in T3-4 u can confirm this probably ?
How can you tell "horn architecture from the inverted V sign and the 3 point sign of SCD?
When you reviewed the spinal cord on both sagittal and axial images, were the axial images obtained by MPR or directly scanning axial?
In this particularly case these images are acquired separately. This is the case for most spine MRI.
It is possible to get thin slice imaging with close to isotropic voxels. That means that the voxels are about the same size in each dimension (including slice thickness). In those cases, you can reformat them into other planes with good resolution. Some spine imaging such as T2 SPACE sequences are done this way, but it's less common than it is in the brain.
@@LearnNeuroradiology when you do T2 Space 3D, are the axial and sagittal images simultaneously taken? Let’s say you have an artifact on T2 sagittal done with Space 3D, would these artifacts transfer over to the Axial MPR taken from the Sagittal T2 3D?
I will have this tomorrow morning. I go search how it's done coz I'm a little bit nervous this my 1st time due to pain on my neck down to my shoulder and elbow.. Hope everything will be ok..
Best of luck. I hope your MRI went well and you get the help you need!
Thank you, my ent is trying to curve me to get contrast and I refuse the mri until he orders it without only
Well, you get about 90% of the information on a cervical spine MRI without contrast, so that's not so bad if you need a cervical spine MRI.
However, if you need a neck MRI because you have a history of tumor, then it's highly suggested that you get contrast. Definitely talk it over with your doctor. Contrast is extremely safe, and when used appropriately can add a lot of information.
@@LearnNeuroradiology contrast put me into stage 5 kidney failure. Please explain how safe that is?
Thanks for these videos Dr. Weinberg. Can we see the same thing with MRI on Face/Neck? I have a patient who had a MRI Face/Neck w and wo contrast done so I want to know before ordering her a c-spine MRI for neck pain.
That's a good idea. MRI of the face is much more geared towards the soft tissues and aerodigestive track, so they are definitely different. Thanks for tuning in!
Thank you I'm scared to get my MRI I'm in terrible pain I want to know what's going on thank you for your help
I'm sorry you're having such pain. Hopefully your MRI can help figure out what is causing the pain. Good luck
getting a spine and neck Bilateral MRI done soon tingling throughout my body and im 21 been for a year 13 doctors cant figure it out also gettin a Emg done.
@@chazzthaspazz4475 wow I know how you feel man pain so bad they have tried everything with me people don't understand real deep pain
@LearnNeuroradiology hi sir im sean patterson 33 male i had mri of my neck last march i have a written report and a c d copy could you maybe give me your opinions on my written results...not with signature like im not presenting it or anything i am just really curious you seem very smart and my neck says disc osteophyte complex at c2 c3 DISC osteophyte complex foraminal stenosis moderate hen again c3c4 foraminal stenosis moderate and other then that smhmorls nodes small in superior endplates of c6 and c7 vertabrea bodys and disc heights otherise maintained i can write out the report but that most of it ..narrow developmental spinal canal but no significant spinal stenosis spine enlightenment within normal limits ..i have questions i think you might be able to answer ill pay if i have too haha but hopefully you get this thankyou sir ps love watching your videos
Well, it really depends on what symptoms you may be having. It sounds like your spinal canal is pretty narrow in the upper cervical spine at C2-C3 and C3-C4. This could lead to a variety of symptoms, or could be asymptomatic because we see it all the time.
What kind of doctor ordered the study for you? That person should be available to discuss any concerns you have about the report, why you got the study, and if it may be related to your symptoms. That's the most important thing is what kind of symptoms you are having and if the things on the report might be causing it.
In short, I think you should talk about it with your doctor. If you have a specific questions after that and you want to email it to me you can send it to admin(at)learnneuroradiology.com
I have question about the cut line in cervical spine (axial sliced what is u can call good 1.5mm or 3 also its give u good diagnostic?
The same thing for sagittal questions it is good to image (cut line 3 or 4 mm )
And if h do 1 mm cut line***in sagittal its wrong (because the pieces very little and or 1 mm for sagittal cervical spine its better than 3 mm ?
Thank for your attention to my question.
Generally it is a balance between noise, acquisition time, and thickness. Thinner slices take more time. Most people believe that 3 mm is a pretty good thickness. 3D sequences such as SPACE have the benefit that they can be reformatted easily into all planes
@@LearnNeuroradiology my Q specific i try to understand if u do sagittal (are from back to front) and made slice's of 1 mm (sagittal ) u get the sagittal of cervical spine in very little slice it is not very thin slice for side view (or its more good?(what is your opinion)
*yes more images ,take more times
I ear that someone really expert talking about 3 mm (but I ask if he talks also on the end on view (axial) and also sagittal.
3 mm is a nice balance for both sagittal (back to front view from the side) and axial (left to right cross section view from below). You can see nearly all pathology without too much noise.
1 mm slices are an advantage for viewing very small structures but lose both contrast (difference between different tissue types) and gain noise
Can you actually visualize the nerves and nerve roots themselves coming off the cord and measure how inflamed they are?
Or can you only measure the size of the space between the foramina?
You can see the nerve roots themselves in the foramina. There are some conditions that make the nerve roots larger or brighter.
There are also specialized techniques for neurography to specifically look at nerves better.
Sir non any hematoma please sir reply
Buongiorno Prof, mi ritrovo con un ependinoma alla spinale,e cominciato tutto con la C2_C3 ora sono passato fino alla C7 a coda di topo , cosa mi consiglia visto che ho il diabete????E visto che mi hanno anche detto che in Italia la fanno solo a Verona,e se non ce posto li,all'estero,perche' e una forma rara,e c'e' il rischio che non mi sveglio piu',grazie,Pignalosa Ciro,Genova ,Italy
Oh, man, I'm sorry I don't speak italian so this is based on a translation from google.
Sorry to hear you have an ependymoma. They are slow growing tumors but often come back and spread. Sometimes you might need another operation or even radiation therapy to treat them. You can talk to your doctors about the options.
I'm not that familiar with hospitals in Italy but I suspect most of the big cities have hospitals that can help you with this. You need a good neuro-oncologist who is familiar with the disease and then you can work from there.
Hello sir I am Indian I lerned cervical spine mri is normal,, but I scanned cervical spine mri he is normal but my hand and leg and some body parts compressed dignosis is normal neck pain and compresson any reson please sir
Would this type of MRI show any tumors in the area? Or in the soft tissue?
Generally speaking, yes. Any tumor of the bones of the spine, spinal canal, or nearby soft tissues would be visible. Most of the times if we're looking for a tumor, we give contrast to make it more likely to see the tumor.
Soft tissue tumors of the anterior neck, like head and neck cancers, you wouldn't see as well.
LearnNeuroradiology ok, thanks for your answer. So you’re saying head and neck cancers would not be seen as good or maybe not at all?
Head and neck cancers, like cancers of the tongue base, tonsils, and vocal cords, are usually evaluated differently. Many institutions use CT (computed tomography) or PET/CT for these types of tumors. MRI can also be used, but it is a slightly different exam tailored to the anterior neck soft tissues. This video specifically concerns MRI of the spine, or posterior and bony neck. Hope this answers your question.
@@LearnNeuroradiology I got hit in the head and had a brain bleed. I feel back and passed out 😵. My neck is making clicking sounds , lots of noise. My question is when they do the MRI are they going to see my brain or just my neck and do I need to have another MRI on my brain because I’m having headaches and I pain and thank you for your time
@@LearnNeuroradiology So you’re saying that when they take the MRI of my neck my spine they won’t see if I have cancer inside my throat because my throat hurts too OK thank you again
Does mri detect cervical instablity
Strictly speaking, no. Instability is inferred from other signs, such as ligamentous disruption or joint degeneration.
The only real way to see instability is dynamic or flexion/extension x-rays.
Hi does this is normal cervical spine?
Yes, this is a normal cervical spine (at least essentially normal)
I agree with you, not a normal curvature, rectified for shure
Can non-contrast cervical spine MRI see a CSF leak?
Sometimes. The first test we often do is a non-contrast MRI of the spine to look for any fluid outside the canal. If a leak is fast and there is a lot of fluid, we can often see it. However, CSF leaks are notoriously hard to see and sometimes require other testing, such as a myelogram.
U didn't explain why this focal area of different marrow signals at vertebral bodies !!!!
It's pretty common to have some mild heterogeneity of the marrow, even in young patients. I assume you are talking about the areas in the inferior aspect of C2 and maybe C5 that are bright on T2 and heterogeneous on T1. These are probably areas of focal fatty marrow or small benign vascular malformations (hemangiomas). If things are T1 bright and suppress on fat-saturation, you know they contain fat and are benign.
In an older patient with a risk of malignancy, you have to be careful about lesions that are T1 hypointense.
🙏🙏 Dear sir
On jenetic solve problem My 2 hands 1 leg are not power... Plz you 🙏🙏🙏 treatment.
Yeah, I'm sorry we won't be able to help you much on here. You're gong to have to talk to your doctors about the problem. Thanks for tuning in though.
You need to go to EMERGENCY ROOM RIGHT NOW. SOUNDS LIKE A STROKE 🧐
@@LearnNeuroradiology What is a T 2. , hyper extensive in a liver what does that mean 😍🥰😂
But can you see arachnoiditis without contrast?
Not really. But isolated cervical arachnoiditis would be very unlikely anyway.
Wish I could send you cd to look at . 😢
Unfortunately I don't really have the ability or time to look at everyone's studies, but I encourage you to talk about any concerns that you have with your doctor. Most of the time they can help answer your questions.
@@LearnNeuroradiology thanks
How long does it take to look over the entire mri
It really depends on the expertise of the reader and the complexity of the study. Plus some time is required to generate the report.
A simple cervical spine MRI with a simple history and few findings, maybe 5-10 minutes.
A complex cervical spine MRI with contrast, a history of surgery or a tumor, and multiple comparisons, maybe 20 minutes or more.
What the name of the app
There is no app but all of my content is available at www.learnneuroradiology.com and here on the youtube channel.
oh and my mri mucosal thickening on floor of right m axillary sinus
Mucosal thickening in the maxillary sinus is very common and most likely not an important issue, but you can ask your doctor.
@@LearnNeuroradiology i am wondering disc osteophyte complex if that means my disc are compressed ? im sure you know the term ..and just your opinion if you think people with shmorls nodes in the neck can i still use the gym weight training for fitness ..im just afraid but my doctor and many others seem to have no.concern and tell me weight training is fine ..and that its not a huge deal
@@seanlatterson I have a lot of MRI changes. Visit a good chiropractor for true advise for there are mechanical loading on your disc that you need to work on. Your normal doctor will not help.
Sir mri reports,,,
1,,vertibaral bodyes show normal hight, aligament curveture and marrow signels intensiti
2,,Iv disc show normal MR morography and signal intensiti pattarn
3,,posterior bony aliment and fecet joint is normal
4,,biletaral neural formina are normal
5,,thecal sac with cervical spinal cord/canol is normal
6,,CV, CM junction are normal
7,,pre, para vertibaral soft tissue is normal.
Canal diameter
C2-c3 c3-c4 c4-c5 c5-c6 c6-c7
13.5 12.7 11.8 11.1 11.3
Impression,,,
No defenite evidence of compressive myelorediokulpathy is seen
Mr stydy of the lumeer spine and spinal cord is normal limit.।।
Please 🙏🙏 see and reply sir
Hi Graduate Gamer, I think you've probably got to talk it over with your doctor and see what else might be causing your symptoms and what this result means for you. Thanks for checking out the videos!
Ok sir thank🌹🌹❤ for reply.।
But I am going two 2,, neurology, neurosurgon doctor , and seen my mri , and ct scan reports and tell normal and give me medicine💊💊 give is best results but for some time
Sir cervical spine connect is the 👂👂because my ent ringing problem time
Please help sir my age is 22 years old
Please help sir my age is 22 years old
Ependinoma C2 C3??¿
There is no mass here. It's a normal case.
Can you review mine?
For various contractual and license reasons, I don't review studies outside of my main job. You should ask your doctors to go through your images with you or let you talk to a radiologist at your institution.
3:49 is not a normal alignment there is a loss of curve there it is too straight.
sitting the head will stay straight. movement so blurry mri. Could lay down instead. trying strong pain pill.
Thanks for checking out the video!
Slice thickness on Ax a bit too much. 😉 😜 😜
Yes, thinner axials are definitely better. Most of the time 3 mm is the standard, but it is possible to have volumetric slices that are reformatted to 1 mm.
Can you take my MRI and make a TH-cam video about it? Literally 3 different radiologists have given me three different opinions on it. I’d like to see your opinion.
Not really. That really amounts to practicing medicine and I don't do that outside of my normal practice. You really have to talk to you doctor about the symptoms and imaging findings.
@@LearnNeuroradiology Is there a thing called CSF flow artifact when the CSF appears to cause “lesions” within the spinal cord. Like the CSF going into the spinal cord on the image but in reality it’s not there. The sequence is T2 SPACE 3D..,
Yes. This is most common on fat saturated sequences, like STIR and T2 fat-saturated. It most often makes a line from the head towards the feet and can make it hard to tell when someting is wrong with the spinal cord sometimes
@@LearnNeuroradiology Even on T2 SPACE 3D there keeps on popping up one white bright spot within the spinal cord, but not on axial. The radiologist are saying it’s CSF flow artifact but it’s twice in a row now same spot.. should I trust them?
It can be hard to tell and that may be why you are getting different opinions. It is important whether the location matches your symptoms. If not, then that may suggest that it's not real
i havnt asked my questions in detail but as you can see radiologist speak s bit more then lamens terms ...
See the other reply, but you should really talk to your doctor about the results. If you have questions about what they tell you, you should first ask them because they know you and have a relationship with you.
@@LearnNeuroradiology i have already talked to my doctor he answers nothing and hes just a gp he doesnt specalize in the spine i got the mri because i kept asking they didnt just order it for themselves put of nowhere i insisted something was wrong .....all he said was i dont need surgury yet if i wasnt having redicular pain yet but still was very mean about the shmorls nodes telling me no limit to activity i can keep bodybuilding and that they shouldnt cause pain i find it very ignorant and not helpful at all ..i am trying to see a specalist now to see more of what im dealing with ...i am simply askinh your opinion on the shmorla nodes and activuty level etc ..im afraid of further damages the disc with smhmorls nodes and i asked you exactly what disc osteophyte complex is ..i know without looking at my mri its not as easy for you to talk about it i apologoze for that much ...i was just wondering your opinions ...i have already gotten as much info i can from my gp he never read the mri just read me the results i got a copy of it myself ..you certainly know more then he does ..on reading a mri ahha ...sorry i know if you looked at my mri it would be easier ..i was just wondering your opinion on shmorls nodes cervical spine can i still lift weights i think it sounds dangerous my doctor said no limit to activity but if there is endplate damage and disc fluid hernating at c6 c7 superior endplatea wouldnt that be strange to just lift weights wouldnt the disc fluid just herniate more and more its just so confusing how the body could continue to work out with these cervical SHMORLS nodes and remember you do not even have to be right or wrong i am just enjoying getting different opinions online that is after all how we learn to ask questions ....our regular gps are sadly overrated and and except for the few that absolutely fabulous doctors we are kind of left to do our own research..iv done my research on shmorls nodes and no matter what size the shmorls nodes small or large im just not sure how the spine can continue to take fitness with weights obviously very heavy isnt good for any spine but its just hard to understand and feel safe about they there can be disc fluid through the endplate into the.bone and just move on in life continuing to be fully active ..i just feel if these shmorls nodes never heal arent they just a guaranteed downward spriral instead of progression..i want to lose 50 pounds again and get into shape but knowing my endplates are broken in other words with leakage ..shmorls nodes sound prettt nasty and there never really talked about or discussed..very little comes up on google im just wondering your opinions on them and ..the term disc osteophyte complex does thst just mean osteophytes at those levels or does it mean the disc are in trouble too ..you can tell me anything you know ? or anything you dont know its all on good fun like even if you give me incorrect info it no harm done here ..just making friendly conversation because i noticed how smart you are from the videos
Schmorl's nodes are really common and we don't know what causes them, other than some focal weakness in the bone. They can be painful, but rarely progress to anything clinically significant.
Similarly, almost everyone has disc bulges and small osteophytes once they reach a certain age. When people say disc-osteophyte complex, what they mean is that there a protruding area which has features of both. They can press on nerve roots and the spinal cord which can cause symptoms.
While certain types of exercise might make it worse, most of the time activity is encouraged. Most weightlifting does not put extra weight on the cervical spine (and shouldn't). I guess I agree with your doctor that you can do most of your weightlifting normally. Just start slow and progress to what you normally would do.
I discourage you from doing anything that directly loads the neck or head, but most people shouldn't be doing that anyway. And don't see a chiropractor.
@@LearnNeuroradiology i understand the nodes are largely ignored unless they reach into am issue that effects nerves spinal cord or if the nodes become so big that they are giant nodes..causing extreme pain and further damage to the adjacent vertabrea and bone marrow edema like i assume if they do get bad peolle start to listen then i find it frustrating though because there still hernations and my doctor doesnt even take follow up mris to see if there progressing or if my osteophyte are getying worse he just wants me to live my lift weights and i someday need surgury deal with then..this is I guess the limbo doctors work in because unless the cord or nerves are involved they have no reason to surgury so they just tell you to do your sports life live etc nothing can be done anyway unless it's bad enough..this however is when we patients feel stuck though because we dont want yo further wear and wear are disc or stimulate more osteophyte growth an or continue to make our s nodes worse..they basically just hit the hammer down and say do what you can do not needing surgury nothing else they can do till then and there not ever going to just say sit idle and gove up nexus obvioisly to move the body is the only healthy thing for our spines ..just frustsrtingin my case I want to still bodybuild and my doctor gets furious not wanting to talk sn or osteophyte..whats your opinion should i continue my routine sir obviously assuming I'm not trying to be mr powerhouse here using 300 pound weights ..anyway lastly you say disc osteophyte complex..my issue wirh mine it says they are foraminal disc osteophyte complex causing moderate stenois in the foramen no in the spinal canal ..so anyway they dont explain whether my osteophytes are compressing and or straining my disk in anyway they just say disc osteophyte complex leaving me to wonder is the disc ok even though there is osteophyte around it..these questions are important when using free weights at the gym
.so if you could help me understand the disc complex a bit more i would really appreciate it.. my doctor acts as should have zero concern about osteophyte disc complex yet he is aware they can lead to surgury he not the radiologist never actually make clear what it means in my case..also i have read articles that from upon the term disc complex because it could be implying many things or less thing and i heard this term can be sloppy and it is better to go into detail talking about the disc and osteophyte separately
In conclusion do you think i can continue to.get back into shape ..i don't normally 1000s of pounds I just use maybe up to the 80 pound dumbbells and i plan to be avoiding certain exercises at least to not irritate the areas as much but if i stop training all together I risk alot of spinal issues from being idle all the time.. i hope this msg speaks for others too and i appreciate your feedback when you have free time sincerely sean
..thanks learnneuroradiology
@@LearnNeuroradiology yes i do moderate lifting for the health of each muscle I don't power lift like when i was young ..just bicep curls bench moderate rowing legs core you know bodybuilding but natural not getting up into the massive weights just keeping it realistic however what exact movements are you telling me to.be clear on ..i will no do them I was thinking shrugs and shoulder press might be too much but then again shrugs do stength the nexk and traps a bit and overhead press can make a strong neck but ya i just want to look and feel good sonlet me know from your wisdom what exercises should be cut and let me know ps i hear alot.then leg extensions are bad and for the knee and that even full range squats and lunges are bettet then leg extensions apparently it puts all the force on the knee and thars not the best or safest way to pump up the quadriceps..keep in touch I'll call you boss because we are your students haha cheers
He have bulging disc c3c4 not normal mri
No. That disc is normal. It's normal to have a certain amount of convexity to the disc. If you're calling that disc abnormal, you're overcalling abnormality.
10:20
Voice not clear
There are other ways to learn this topic other than these videos if they are not for you, I guess
Horrible axial slice set up.
Well, don't leave the channel in suspense.... what do you recommend?
great video but why so much fried voice?