MRI of the cervical spine

Definition / introduction

In magnetic resonance imaging (short MRI) or magnetic resonance examination is an imaging procedure that does not require harmful radiation exposure like X-rays or CT scans.
The examination creates sectional images of the human body.

The basis for the principle of MRT is the special property of hydrogen atoms, which also occur in the human body, an inherent angular momentum (Nuclear spin) to own. In this way they create a very weak one of their own Magnetic fieldthrough which they can be influenced from the outside by a large magnet such as small bar magnets.
Such a large external magnet is built into the magnetic resonance tomograph. The device emits an electromagnetic signal and then stops the time until the particles are aligned again.
Depending on the tissue, the hydrogen particles are deflected longer or shorter so that, for example, between Adipose tissue and blood can distinguish. The device uses the incoming electrical signals to create sectional images of the inside of the body, on which pathological changes can be shown.

application

As described, the patient is undergoing an MRI scan no radiation exposure as exposed to CT or X-ray because of the applied magnetic field completely harmless for the body is. The MRI also offers a higher resolution than computed tomography or a conventional x-ray.
Especially soft tissues like Musculature, Support fabric and internal organs can be assessed very precisely by a magnetic resonance examination.
Bony structures however, with a Computed tomography examination represent far better than with a magnetic resonance.

Since an MRI of the cervical spine has a longer application time (approx. 20min) than a CT, its importance in an absolute emergency is of secondary importance. An MRI examination of the cervical spine is also essential expensive than computed tomography, furthermore because of the limited number of devices Appointments are more problematic.

For a magnetic resonance imaging examination of the Cervical spine there can be several reasons (Indications) give. On the one hand, an MRI scan can be used Herniated disc of the cervical spine a Disc protrusion of the cervical spine be proven or excluded.
Please also read our special topic: MRI for a herniated disc

That too Spinal cord can be checked for acute or chronic damage, as well as that Bone marrow for example on inflammation or Tumors can be examined.
Also the Vertebral bodies (Corpus vertebrae) as bony structures and the spinal canal they form (Vertebral canal) the cervical spine can be examined. In this way, active vertebral body or intervertebral disc wear can be detected.
In addition, you can Vascular malformations represent. Also tumors of the spinal cord skin (Meningiomas) or metastases in vertebral bodies can be detected.
Furthermore, a narrowing of annoy and also inflammatory processes as in the context of rheumatic diseases or one MS disease being represented.
Please also read our special topic: MRI in MS

procedure

Every patient has to face a MRI scan of the cervical spine on the procedure informed by receiving the information sheet from the doctor or trained staff and finally signing the consent sheet. Otherwise are from the patient's point of view no further preparations hold true.

The clothing must be removed for the examination. It is very important to everyone metallic objects such as jewelry, piercings, hearing aids or credit cards. These are attracted by the applied magnetic field and can injure the patient due to their acceleration. The patient should lie in the most comfortable position possible on the examination table and is then placed in the MRI " tube“Driven in.
When examining the Cervical spine this must be fixed, as any movement can render the sectional images unusable. Be for it head and Shoulders usually fixed by a kind of grid.

For certain questions, so-called Function recordings the cervical spine. Relocations are carried out during the examination, which enables functional changes to be shown. For example Narrowing of the spinal canalthat only occur in certain positions can be detected.

Since the magnetic fields that are switched on and off generate relatively loud, knocking noises, the patient is offered hearing protection in the form of earplugs before the examination.

Duration of the MRI of the cervical spine

An MRI scan of the cervical spine takes approx. 20 minutes. The higher the desired resolution of the sectional images, the longer it generally takes to take the images.

Contrast media

Most MRIs come without the administration of Contrast media out. For example, a Herniated disc of the cervical spine Represent with sufficient accuracy even without a contrast agent, since the tissue of the Band washers can be sharply delimited from the environment.
If the question for the MRI does not make administration of contrast medium necessary, its administration is dispensed with, as this would cause a further (albeit small) Represents surgery on the patient.

Is the use of MRI with contrast agent is usually displayed Gadolinium DTPA used, which improves the tissue representation of an MRI image. Gadolinium DTPA is used, for example, in the diagnosis of Multiple sclerosis (MS) is used to find active herds.

Also in the tumor diagnosis and in the representation of inflammations Gadolinium DTPA great importance to it.

General is Gadolinium DTPA very well tolerated, allergic reactions occur in only 0.1-0.01% of applications. The contrast agent is injected into the arm vein through a cannula and then distributed throughout the entire area Body circulation.
Immediately after the injection it can occasionally become too Sensation of warmth or cold, malaise or a headache come. However, these symptoms usually subside quickly.

However, if unusual symptoms occur even after the examination, the patient should not hesitate to ask the doctor for advice. After a few hours, the contrast agent is completely over the Kidneys eliminated. Gadolinium DTPA is therefore not suitable for patients with Kidney disease. In case of doubt, the creatinine values ​​(Kidney values) of the patient to be examined.

Further information can also be found at:

• Contrast media
  and
• MRI with contrast agent

MRI of the cervical spine for claustrophobia

During the examination, the patient usually lies on his back on an examination table, the head, neck and shoulders are fixed with a grid, since the smallest movement makes the imaging unusable.
Then the patient is placed head first on the table in the "tube" hazards. Since only recordings of the Cervical spine are made, the table does not have to be moved all the way into the machine, so that a large part of the body does not disappear into the MRI machine. The size of the device's diameter depends on the type of device. Also whether the head end of the MRI "tube“Is open and the patient can look out front differs from model to model. There are now so-called open MRIsthat are no longer even tubular and patients with claustrophobia can make the examination a lot more pleasant.

Most patients have a more or less pronounced fear of the MRI examination. Anyone who suffers from claustrophobia should not be ashamed and discuss this with the doctor before the examination.
There is always the option of getting one Drug for sedation to give. The only important thing here is that, due to the effects of the medication, you are usually not allowed to drive a car immediately after the examination and that you should organize an accompanying person.
As a rule, active ingredients are from the group of Benzodiazepinese.g. Dormicum® used

Against the noise caused by the magnetic fields switching on and off, the patient receives ear plug or Radio headphones. In the event that the patient has to abort the examination due to a panic attack, an alarm button is pressed in his hand beforehand. The entire examination is carried out by the attending physician (the radiologist) monitored so that the patient is not alone during the entire process and in an emergency (e.g. if you have a panic attack) can be intervened immediately.

You can find extensive information on how to carry out claustrophobia under our topic: MRI for claustrophobia

MRI of the thoracic spine

If a patient's symptoms cannot be precisely localized due to the symptoms, an MRI examination of the thoracic spine may also be indicated. The principle is the same as for an MRI scan of the cervical spine.
To examine the thoracic spine, the patient must at least completely undress the upper body and remove all metal-containing objects again. Patients with a pacemaker are generally not allowed to have an MRI scan!

The patient lies on a mobile couch that is pushed into the tube for examination. A frequent indication for an MRI examination of the thoracic spine is the suspicion of a herniated disc. A herniated disc in the thoracic spine is rather rare (Much of the herniated disc is in the Lumbar spine localized), but should be excluded in the corresponding area in the event of severe back or chest pain.

The spinal cord or the intervertebral discs can be assessed very precisely as soft tissue in the MRI of the thoracic spine, whereas the vertebral bodies are better represented as bony structures in conventional X-rays or CT.
Tumors in the spinal cord area often have symptoms similar to a herniated disc and can also be diagnosed with an MRI scan. Metastases in the bone marrow (e.g. after breast cancer) can be displayed in the MRI.
Inflammation of the disc space (Spondylodiscitis) as soft tissue is also visible in the MRI.
After whiplash injury (e.g. from a car accident) injuries to the spinal cord of the thoracic spine or bleeding in the thoracic spine can be excluded in the MRI.

Read more on this topic at: MRI thoracic spine

MRI of the cervical spine in multiple sclerosis (MS)

Patients who at Multiple sclerosis (MS) should have an MRI scan of the cervical spine and at regular intervals MRI of the thoracic spine receive. Multiple sclerosis is a chronic inflammatory disease of the central nervous system (belong to the brain and spinal cord), where the Medullary sheaths to the annoy to be attacked.

These so-called demyelinating foci are located in the brain as well as in the spinal cord and can be shown in the MRI cross-sectional images.
To detect fresh flocks you can Contrast media containing gadolinium be used. In contrast to intact tissue, the Blood-brain barrier In the area of ​​the acute lesions, the contrast agent is permeable so that the foci of demyelinating can be detected in the MRI.

If with one Multiple sclerosis-Patient failures in arms or legs occur or urination disorders occur, the demyelinating foci are in the Cervical spine or. Thoracic spine to be suspected and can be visualized with an MRI examination.
In order to distinguish old MS foci from new ones, it is advisable to administer contrast medium during the MRI examination.

• MRI in MS
• Multiple sclerosis

Herniated disc of the cervical spine

Herniated discs (Disc prolapse, Prolapsus nuclei pulposi) the cervical spine are a rarity with around 15% of all herniated discs. For one, the cervical spine bears much less weight than, for example, the Lumbar spine and on the other hand, it performs far less powerful movements than this.
Chronic herniated discs of the cervical spine permanent bad posture are more common than acute herniated discs, such as those that can result from jerking the head.

In a herniated disc, the inner gelatinous core (Nucleus pulposus) of the Intervertebral disc (Intervertebral disc) through the outer fiber ring (Annulus fibrosus). The reason for this can be wear and tear or, less often, an injury.
The ones from the Spinal cord emerging and thus immediately adjacent so-called Spinal nerves are irritated by the emerging core of the intervertebral disc and the affected person feels one severe, sharp pain along the nerve tract.

With a herniated disc in the lower neck area, the pain often radiates to the fingertips because the irritated nerve is the poor provided. Numbness can also occur. If the intervertebral disc presses directly on the spinal cord, a Paraplegic symptoms arise, which is relatively dramatic in the area of ​​the cervical spine, since the for the breathing relevant nerve tracts may be impaired.

After the questioning and physical or neurological examination by the doctor, the diagnosis must be confirmed by imaging.
The Magnetic resonance imaging of the cervical spine is the method of choice here because it depicts soft tissue structures such as intervertebral discs, spinal cord or nerve roots much better than X-rays or CT.
In the MRI, the herniated disc of the cervical spine can be precisely localized and the direction in which the disc has advanced. As a rule, administration of a contrast medium is not necessary to diagnose or exclude a herniated disc of the cervical spine.

Only occur in the case of a herniated disc in the cervical spine Pain and restricted mobility, but no reduction in strength or neurological symptoms, should be treated conservatively at first. The majority of patients are after the administration of pain relievers, anti-inflammatory and muscle relaxants Medication, such as Immobilization and later physical therapy no more surgical intervention necessary.
If the conservative therapy fails or immediately in the event of muscle weakness or neurological symptoms, surgical intervention is carried out. First, the leaked intervertebral disc tissue is surgically removed. As a therapy option there are then one stiffening of the neighboring vertebral bodies (Spinal fusion) or the use of a artificial disc for optional.

For more information, see: Herniated disc of the cervical spine

Representation of nerves

As soft tissue, nerves can be visualized much better in an MRI of the cervical spine than in a conventional X-ray or CT.
At a Narrowing of the spinal canal (Spinal stenosis) can be shown with the help of an MRI examination to what extent the spinal cord or individual nerve roots are compressed. With a modern so-called Magnetic resonance neurography damage to nerves can be precisely localized and displayed.
Furthermore, certain nerve diseases such as multiple sclerosisthat next to the brain also affect the spinal cord, can be seen in an MRI image of the cervical spine. Also a root syndrome of the nerves of the cervical spine (cervical radiculopathy), i.e. chronic or acute irritation of one or more nerve roots, can be shown by an MRI image. The symptomatology, consisting of Sensory disturbances, pain and paralysis, is caused by herniated discs, degenerative bony changes or masses caused by tumors or inflammation (e.g. Abscesses, borreliosis, spondylodiscitis) caused.
If there is any suspicion, an MRI scan of the cervical spine can look for nerve compression, inflammation or masses.

inflammation

Various inflammatory changes in the cervical spine can be seen with an MRI scan. The MRI is usually used to detect inflammatory processes Administration of contrast medium. The contrast agent (e.g. Gadolinium DTPA) accumulates in inflamed and healthy tissue to different degrees, so that the inflamed area appears in a different shade of gray in the image than the surrounding healthy tissue.

Because of its extremely good assessability of the soft tissue, the MRI is the examination of choice for the detection of Disc inflammation (Spondyodiscitis). Spondylodiscitis is an inflammation of the intervertebral disc and the two surrounding vertebrae, which can be bacterial or, more rarely, rheumatic. The MRI shows signs of inflammation up to and including abscess.
The symptoms are similar to those of degenerative spinal diseases and can be of fever, Night sweats and weight loss may be accompanied. The pain kicks in especially at night on, pioneering is a strong one Pressure or pounding pain over the diseased vertebrae.
A highly effective antibiotic therapy is unavoidable, depending on the course, surgical intervention with removal of the diseased intervertebral disc tissue and subsequent stiffening of the vertebrae may be necessary.