MRI of the spine

introduction

Nowadays, the MRT is one of the most frequently used diagnostic tools in medicine, which is primarily characterized by the low incidence of side effects.

definition

Magnetic resonance tomography, or MRT for short, is a method of cross-sectional image diagnosis that records images of the inside of the body by generating a magnetic field. The strength of the magnetic field used in medicine is usually between 1.5 and 3 Tesla. Because it Soft tissue- as well as Nerve tissue can represent very well, it is suitable in the diagnosis of Spine especially for assessing what is going on in it Backmarks.

Indications

There are various indications for an MRI of the spine. Due to its specificity for the soft parts and the nerve tissue, it is particularly suitable for displaying Spinal ligaments, Tumors, as well as for the diagnosis of various spinal cord diseases, such as inflammation or the common disc prolapse.
No The indication would be the suspected Fracture of a vertebral body, because bones in the so-called Computed tomograph, CT for short, are better represented.
Since that MRI -in contrast to CT Not is radiation-damaging and so far no side effects have been described in this investigation, this procedure is preferred to CT in children and pregnant women, since these patients are spared radiation exposure and the associated side effects.

Contraindication

Due to the strong magnetic field effect, it must be done before an MRI examination metallic objects be respected in the body. Patients with implanted Pacemakers should consult their cardiologist beforehand.
Even though most medical products that are implanted in the body are now MRI-compatible, MRI suitability should always be clarified in advance. Other contraindications result from the use of the Contrast agentwhich is described below.

Duration

MRI exams usually take a little longer. A detailed cross-sectional imaging of the spine can usually be done 20-30 minutes last. Specific examinations and the use of contrast media can vary the duration.

Contrast media

Contrast media are substances that are used in imaging diagnostics to better represent certain structures in order to be able to answer specific questions about diseases. A different contrast medium is used depending on which procedure is used. A distinction is made with MRI extracellular, i.e. contrast agent that does not penetrate cells and that intracellular Contrast agent, which mainly accumulates in cells and tissue.
Extracellular is most commonly used, typically that Gadoliniumwhich is about the Kidneys is eliminated. Since the accumulation of this contrast medium depends on the kidney function, it is very important to know before administering the medium Check kidney values, because if their function is restricted, the contrast agent can accumulate too much and possibly lead to kidney damage. This contrast agent leads to a Lightening from the affected areas. These are mainly vessels that then light up brightly in the image.
The intracellular contrast medium varies depending on the representation of the organ. Iron oxide particles are suitable for Illustration of the liver in which Manganese compounds especially the pancreas light up.
Contrast media can also be used Side effects to lead. Already when injecting into the vein through an access it can become a Burning and itching on the skin or leakage of the contrast agent into the arm, which can lead to painful swelling. In itself that is MRI-Contrast media better tolerated as x-ray contrast media containing iodine, but they solve in rare cases allergic reaction that most often manifest on the skin.

costs

With a medically justifiable one indication is the MRI of the spine in Germany financed by health insurance companies. Depending on whether it is private insurance or statutory health insurance, the radiologists are billed differently by the financing institutions, with the return for the doctor being higher for private payers than for those with statutory health insurance. The cost of an MRI of the entire spine is made up of the individual costs of each Spine Sections together: cervical, thoracic and lumbar spine. The images are individually combined to form a whole, as the individual images offer a better resolution than an image of the entire spine.
The cost of an MRI of the respective sections for private patients is at least € 244.81, but a maximum of € 612.08. The increase in costs arises when, in addition to simple imaging, the recordings are made in different positions, contrast media is used, computer-technical reconstructions are necessary and the radiologist evaluates the images. The longer and more complex the examination in the complete package, the higher the costs. For those with statutory health insurance, the costs are € 124.60 per section.

MRI of the lumbar vertebrae

The 5th Lumbar vertebrae educate the Lumbar spine, the lower part of the spine between the thoracic spine and the Sacrum. They are numbered L1 to L5 for classification, which enables precise assignment on the imaging, such as CT, MRI or X-ray.
A lumbar vertebra consists of one Vertebral bodies (Corpus vertebrae) and one Vertebral arch (Arcus vertebrae). From here they pull sideways Transverse processes (Processus transversi) and backwards the Spinous processes (Processus spinosi). They serve the muscles as an attachment point for attachment. Together with the vertebral body, the vertebral arch forms that Vertebral hole (Foramen vertebrae), in which the Spinal cord is located.
The vertebral holes of all vertebrae in their entirety form the Spinal canal. The peculiarity of the lumbar spine, however, is that from the first or second lumbar vertebra the spinal cord no longer runs as a single cord, but only the spinal nerves like individual thin threads hang down (the so-called Cauda equina). Like the spinal cord in the spinal canal, these are also Nerve water, Vessels and nerves. Apart from the vertebral hole, two vertebrae lying on top of each other also form one laterally Intervertebral foramenthrough which the Spinal nerves (Spinal nerves) pass through. These and the spinal canal are relevant to understanding the herniated disc, which is described below.

MRI for a herniated disc

A herniated disc is one that develops slowly or suddenly Bulging of Disc material into the so-called spinal canal, in which the spinal cord runs. This is the so-called Nucleus pulposus, i.e. the gelatinous core of the intervertebral discs, which with age increases Water loss loses elasticity.
If the spine has been overloaded for years through work, competitive sport or pregnancy, wear and tear is favored and a herniated disc is more likely to occur. A herniated disc occurs not only backwards into the spinal canal, but also laterally, where the Nerve root exit.
Depending on which area of ​​the patient's body movement, feeling and / or reflexes are disturbed, an assumption can already be made during the physical examination as to which area of ​​the spinal column the herniated disc is located in. This protrusion can lead to paralysis, numbness or pain due to pressure on the spinal cord or the nerve roots. The lumbar spine is most frequently affected, and when it is affected, symptoms are mainly in the Genital region and legs power.
In order to differentiate what kind of cause lies behind the complaints, the is best suited MRI the spine, which shows the intervertebral discs best in contrast to other imaging methods. With the addition of the contrast agent, a further distinction can be made between tumorous and inflammatory causes and a herniated disc can be specifically represented by excluding it. Therapy can be conservative or surgical, depending on the necessity and severity of the symptoms. Conservative therapy includes relieving the load on the spine, whereby strict bed rest is not necessary, as is medication for pain relief specific physiotherapy.
In the case of acute symptoms of paralysis, however, it is necessary to relieve the nerves, so that the surgical route should be taken.

Please also read our special topic: MRI for a herniated disc

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multiple sclerosis

The MRI of the spine and the brain is the most important criterion for the diagnosis of the Multiple Sclerosis (MS), a chronic inflammatory autoimmune disease of the nervous system. In addition to the brain, multiple sclerosis also in the spinal cord occurrence. The relevant demyelinating of the nervous system that occurs in multiple sclerosis can be shown very well as lesions in the MRI. Localized inflammations that have arisen from this process are called lesions. Due to the different weightings of the MRI, the lesions can be distinguished by their different degrees of Illumination or darkeningto assess the severity of the disease. According to certain criteria, the McDonald criteria, temporally and spatially emerging lesions are assessed in the MRI. In this context, the presence of a few lesions on the MRI at the onset of the symptoms is considered to be an unfavorable prognosis.
The MRI becomes relevant in Early diagnosis multiple sclerosis. In a phase in which a neurological examination or monitoring of the cerebral fluid still does not provide any evidence of multiple sclerosis, an MRI can already show lesions.It is therefore advisable to carry out an MRI even if there is the slightest suspicion without clear clinical and laboratory signs.
An MRI with suspected multiple sclerosis should be performed with a contrast medium (usually gadolinium). Since the MS herds are metabolically active Lesions and the contrast agent accumulates mainly in the metabolically active tissue, it can highlight the lesions in the image even more or even reveal foci that would otherwise not be visible.
If there are risk factors for the contrast agent, a so-called native MRI, i.e. without contrast agent, is sufficient.
The relevance of the MRI is also characterized by the fact that the symptoms of a patient in the presence of multiple sclerosis can be assigned to the locations in the MRI and thus explained. The symptoms are therefore neurological deficits in the places where these foci are located.

Please also read our article on this MRI in multiple sclerosis.