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Comparison of Limited MRI of the Cervical Spine Using 3-D T2 SPACE Versus Conventional Imaging for the Evaluation of Spinal Canal and Neural Foramina Narrowing 2013

Category General Spine Luis E. Garcia
Frank Berkowitz, MD
Anousheh Sayah, MD
Purpose The lifetime incidence of neck-related pain in the population is reported to be as high as 67%. In 2006, some 13.2 million patients visited either a physician office or a hospital for neck pain, which constituted about 1% of all health care visits. Cervical spondylosis and stenosis constituted 58% of health care visits associated to neck pain. Disc herniations account for 20-25% of cervical radiculopathy, mostly in the younger population. A cervical spine MRI costs an average of $2000 and takes about 15-20 minutes to perform. Reducing MRI scan time while preserving diagnostic accuracy increases patients' comfort and reduces healthcare costs. In this study, we evaluate the accuracy of an MRI limited protocol utilizing a 3D T2 SPACE (Sampling Perfection with Application-optimized contrasts using difference flip angle Evolutions) sequence for evaluation of spinal canal and neural foraminal narrowing in the cervical spine versus conventional imaging sequences. Materials & Methods This is a retrospective review of 100 consecutive non-contrast cervical spine MRI studies performed in a 1.5 Tesla magnet (Magnetom Avanto; Siemens; Germany). Each study was converted into two separate exams. One exam contained the "conventional" sequences used in the evaluation of the cervical spine and included sagittal T1, TSE T2, and STIR, and axial TSE T2 sequences (total time 16 minutes and 48 seconds). The other exam contained "limited" sequences, which included sagittal T1 and 3D T2 SPACE with axial reformat (total time 8 minutes and 2 seconds). One fellowship trained neuroradiologist and one neuroradiology fellow (ABR certified) each independently reviewed 50 separate cases. The "conventional" imaging exams were reviewed first, followed by the "limited" sequences exams several days later. At each disc space, we evaluated for the presence of spinal canal and neural foraminal narrowing. Sensitivity and specificity of the "limited" study was calculated using the "conventional" study as the standard-of-care. Results Of the 500 total cervical spine disc levels evaluated, the sensitivity and specificity of the limited study was 93% and 98% for spinal canal stenosis and 94% and 86% for neural foramina stenosis, respectively. The accuracy of the limited study was 98% for spinal canal stenosis and 87% for neural foramina stenosis. Conclusion The limited cervical spine MRI protocol has high sensitivity and specificity for spinal canal stenosis and high sensitivity for neural foraminal stenosis, with slightly lower specificity for neural foramina stenosis. The exam also has high accuracy for spinal canal stenosis and neural foraminal narrowing. As this protocol can be completed in half the time of conventional imaging, it can potentially reduce cost and exam discomfort for a large subgroup of patients with neck pain and radiculopathy secondary to degenerative changes. References 1. Baskaran, V, et al. Myelographic MR Imaging of the Cervical Spine with a 3D True Fast Imaging with Steady-State Precession Technique: Initial Experience. Radiology, 227: 585-592, May 2003. 2. Meindl, T, et al. Magentic resonance imaging of the cervical spine: comparison of 2D T2-wieghted turbo spin echo, 2D T2*weighted gradient-recalled echo and 3D T2-weighted, variable flip-angle turbo spin echo sequences. European Radiology 19(3):713-21, 10/2008. 3. Ross, JS. Newer Sequences for Spinal MR Imaging: Smorgasbord or Succotash of Acronyms? AJNR AM J Neuroradiol 20:361-373, 1999 4. Shim, JH, et al. A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen. Eur Spine J. 2009 August; 18(8): 1109–1116. 5. Stafira, JS, et al. Qualitative Asssesment of Cervical Spinal Stenosis: Observer Variability on CT and MR images. AJNR AM J Neuroradiol 24:766-769, April 2003 6. Todd, AG. Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med (2011) 4:168–174 7. Website: The Burden of Musculoskeletal Diseases, Chapter 2: Spine: Low Back and Neck Pain. Http://www.boneandjointburden.org/pdfs/BMUS_chpt2_spine.pdf. Copyright 2011. Last accessed on 12/03/2012.