MRI of the cervical spine with or without contrast: indications, technique

Modern diagnostic studies based on recording the electromagnetic response of atomic nuclei, of which the structures of the internal organs of the human body (magnetic resonance tomography) consist, are in many cases the most informative noninvasive variants of visualization of pathologies invisible at external examination. In the process of scanning, the surface of thin sections (sometimes up to 1 mm) is scanned in successive multiple perspectives, so the idea of an internal structure is obtained most accurately, enabling the computer to reconstruct a volumetric image of the investigated part of the body. In addition, X-rays are not used to study this method-no radioactive irradiation occurs, and the action of electromagnetic waves on a human body placed in the magnetic field created by high-voltage currents is considered to be practically unimportant. MRI of the cervical spine allows visualization of muscular, nervous, vascular cartilaginous and articular tissue. As a result of the examination, you can not only assume, but also accurately detect tumors, ischemic foci, hernia, stratification and inflammation, that is, structures and pathologies, which are not given comprehensive information by conventional methods based on the use of x-rays.

[1], [2], [3]

Indications for the procedure

Complaints of patients for discomfort or pain in the collar zone; tingling, sensory disturbance, disturbing in some areas of the face, neck, shoulder girdle, hands; motor discoordination; headaches, dizziness, fainting and fainting; hearing and vision disorders.

The basis for the recommendation for examination is the assumption of congenital anomalies, neoplasms (the most informative MRI with contrasting), cerebral circulation disorders, inflammatory or degenerative and dystrophic processes in the muscular, vascular and nerve tissues, fractures (dislocations, sprains) in the indicated vertebral column, .

Often, such complaints are grounds for recommending a magnetic resonance study not only of the neck but also of the brain structures.

[4], [5], [6], [7]

Preparation

There is no need for preliminary preparatory measures before the MRI of the cervical spine.

If a survey is planned using a contrast substance, then it is performed on an empty stomach or after five to six hours after eating.

Immediately before the procedure, the patient takes off all metal objects, including earrings, clothes from the upper body and disguises himself in a robe of one-time use, which he will be given before placing him in the apparatus.

[8]

Technique MRI of the cervical spine

After changing clothes, the patient lays down on the moving table. If necessary (if the patient is not sure that he can not move for about half an hour), the doctor fixes parts of his body, in this case - the head, chest and upper limbs, clamps and / or straps. After this, the table enters the ring circuit and stops when it is at the level of the armpits. All the time the procedure for obtaining clear informative pictures patient should lie without moving.

The doctor goes into the next room, turns on the machine and monitors the process on the computer monitor. There is an opportunity for the patient to communicate with the doctor via internal communication.

During the procedure, the patient hears soft clicks and feels minor heat flows in the study area. There are no pain sensations during magnetic resonance imaging.

Young children, who can not explain the need to maintain the immobile position of the body, the procedure is carried out under general anesthesia. In the same way, patients with claustrophobia can be examined.

In the direction may be indicated different structures to be studied. Suspecting atherosclerosis, thrombosis, stricture of arteries of this localization, the doctor recommends making an MRI of the vessels of the cervical spine. Magnetic resonance angiography can be done without the introduction of contrasting substance and with its application. The device for 10-15 minutes will make the necessary number of images in different angles with a cut in 1mm and subsequent volumetric reconstruction of the main arteries that provide blood flow in the cerebral vessels.

Patient's complaints pointing to cerebrovascular dysfunction are the basis for recommendations to simultaneously perform an MRI scan of the brain and cervical spine, which will make it possible to see the most current detailed three-dimensional complex image of the head and neck structures, on which the craniovertebral transition will be seen - the structure formed by the occipital the skull base of the skull and the two (first and second) vertebrae of the cervical region.

Sometimes the indications are made in isolated MRT craniovertebral junction, but much more often this zone is explored with the cervical spine.

To concretize visualization in areas with a branched network of vessels, MRI of the cervical spine with intravenous introduction of contrast substance is recommended for a clearer visualization of the object. Especially effective this method reveals neoplasms, because their growth and development requires increased blood supply.

Contrast substance, administered intravenously, accumulates on sites provided with an extensive vascular network. Also, the presence of contrast helps to conduct an angiographic study more effectively.

In magnetic resonance imaging, contrast is used based on gadolinium - a soft, highly soluble metal - lanthanide. It is positioned as absolutely safe, however, everything is not so unambiguous, and modern studies indicate its ability to accumulate in the brain tissues, causing intoxication.

The duration of MRI of the cervical spine is on the average 15-20 minutes, with the use of a contrast substance - just over half an hour.

Conclusion on the results of the study can be collected in about an hour on paper or electronic media.

Contraindications to the procedure

Patients with any electronic or metal implants, other than titanium, and non-removable prostheses, magnetic resonance imaging is not performed. Severe mental illness, pronounced claustrophobia also prevents the patient from staying in motion.

Patients with dentures and braces may undergo an MRI scan of the cervical spine, but their availability should be advised by a physician.

Temporary contraindications are the first three months of pregnancy, decompensated heart failure, the precomatous and comatose state of the patient, intoxication with psychoactive substances, delirium, nonmetallic implants, devices and prostheses (insulin pumps, clips stopping blood, valve prostheses, etc.); tattoos, applied with the help of metal paints - because of the possibility of a burn.

Additionally: magnetic resonance imaging with contrast is not performed in patients with allergies to contrast agents, hemolytic anemia and impaired renal function, to future mothers.

[9], [10], [11], [12], [13]

Normal performance

The medical conclusion of magnetic resonance tomography fully illuminates the picture of pathological changes in this part of the spine.

What does MRI scan of the cervical spine?

The tomogram shows the osteochondrosis of the cervical spine, various deformations of intervertebral discs, growths, dislocations, fractures.

Well visualized congenital defects in the structure of the spinal column, in addition - acquired pathologies, the consequences of diseases and injuries. You can not only see the narrowing of the spinal canal, the consequences of fractures, dislocations, but also often establish the cause that led to the formation of defects.

Hernia of the cervical spine can be accurately diagnosed only with the help of MRI.

The tomogram shows blood flow disturbances and their causes in the form of vascular lesions: hematomas, ischemia, inflammation, neoplasms, atherosclerotic plaques, blood clots, pathological vessel deformations - bends, loops, constrictions, bundles, deviations, dysplastic changes.

Inflammatory processes in the near-vertebral and cervical soft tissues are well visible, including suppuration.

Infections affecting the bone elements of the spine and the spinal cord, degenerative modifications of nerve fibers (multiple sclerosis) can be diagnosed by a magnetic resonance tomogram.

Primary neoplasms of this localization, as well as metastatic ones, have a specific appearance and are determined during MRI.

Fresh fractures of bones also show a printout, however, for their visualization it is better to use radiation diagnostics.

[14], [15], [16], [17]

Interpretation of the MRI picture of the cervical spine

In a person with a healthy spine, the examined elements of bones (vertebrae, discs between them, joints) with a smooth surface, the same shape and height are visible on the computer monitor, without disruption of integrity, surface curvatures symmetrically located in the appropriate places. Nerve fibers of the spinal cord are clearly traced, the endings of the spinal nerves are not infringed, there are no signs of inflammation (swelling, bruising), there are no other visible defects.

In violation of the integrity of the body or the vertebrae, clear lines of fractures, cracks or dislocations of parts of the damaged vertebra are seen. With compression fractures, parts of the vertebrae are very rarely displaced, and the origin of such a fracture can be determined from a tomogram. Osteoporosis is clearly visible - bone structures are not dense, sparse. Tumor origin of compression is also well differentiated precisely on a tomogram.

The main advantage of magnetic resonance imaging before radiation methods is a clear visualization of nerve fibers, which makes it possible to detect destructive changes in the spinal cord that appear during sprains, sprains, spinal fractures.

Hernias of intervertebral discs are visualized as arcuate deformations that extend beyond the vertebrae. Noticeably a violation of the integrity of the outer fibrous wall through which the contents of the core are viewed. Strangulated nerve endings located nearby are clearly visible.

The picture shows a characteristic unevenness of the narrowed canal of the spine with dorso-median protrusion of the disc, and an even more neglected stage is seen when the protrusion becomes a hernia. The paramedian hernia often interacts with the ends of the spinal nerves, causing their displacement, squeezing or fusion with structural elements localized nearby.

Primary and metastatic neoplasms, wherever they are located - in the spinal cord and on its membranes, bone structures, are clearly visible on the printouts. Sometimes they sprout into nearby tissues, can cause compression and displacement of both the spinal cord and its nerve endings, often complicated by severe destructive changes in the spine.

Complications after the procedure

When all the conditions for conducting the diagnosis of the cervical vertebral column with the help of a method based on nuclear magnetic resonance phenomena are not threatened by any negative consequences after the examination. Currently, this method is considered the safest of all the most informative existing diagnostic procedures, allowing visualization of the internal structure of the spinal column on the neck and nearby tissues.

Unwanted consequences can arise if the contraindications are not observed in the form of failure of implanted electronic devices, heating and displacement of the metal particles of the implants.

In the study with the introduction of a contrasting substance, an unexpected reaction of sensitization may occur, but under the conditions of a medical institution it is quickly stopped by the drugs available for such cases in reserve.

Violation of contraindications can lead to intoxication of the patient's body with diseased kidneys by contrast agent due to its slow excretion.

Also, if the nursing mother has neglected the recommendation to interrupt the feeding for the day (to remove the contrast from the body), the baby may be poisoned.

Other complications after the procedure are unlikely. Special care after the procedure is not required.

[18], [19], [20], [21]

Analogues

If there is a question, what diagnostic method to choose an X-ray or MRI, then it is necessary to be guided by the alleged diagnosis.

Radiodiagnosis is more informative if a diagnostic conclusion is needed about the state of the bone tissue of the spinal column. This is X-ray and computed tomography. They are preferable for fractures and dislocations, in addition, X-rays - the most affordable diagnostic method, both in price and in prevalence.

And magnetic resonance diagnostics is more suitable for solving the problem of visualization of muscular, nervous and vascular tissue - inflammation, degenerative-dystrophic modifications, tumors, primary and metastatic. In addition, the level of safety of MRI of the cervical spine is much higher.

You can make ultrasound of this part of the body. Visualization of internal organs with the help of ultrasonic waves is considered the safest, it is shown even to pregnant women - ultrasound scanning is subjected to an unborn child. Nevertheless, some tissues of the body remain partially inaccessible to ultrasound and among them - bone. Ultrasonic scanning is available for hernias, protrusions, it can detect narrowing of the spinal canal, curvature and age-related deformities, and assess the condition of the surface of the spinal cord. However, this method, in addition to its main advantage - security, also has a number of shortcomings. Ultrasound data often leads to overdiagnosis (they can indicate a pathology that does not exist), so anyway many doctors need to specify the diagnosis by another method.

[22], [23], [24], [25], [26], [27], [28]