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S.P.A.C.E. Age Imaging of the Cervical Spine: More Than Meets the Eye 2014

Category General Spine Adam W. Myers, M.D. Falgun H. Chokshi, M.D., M.S. Purpose Conventional magnetic resonance imaging (MRI) of the cervical spine relies on multiplanar T1 and T2 weighted (w) turbo- or fast-spin echo images (TSE or FSE), with gradient-recall echo (GRE) images variably included for disc vs. osteophyte differentiation and for trauma. The T2-w spin echo sequences can be acquired relatively quickly, however, they suffer from CSF flow artifact, susceptibility artifact by hardware, poor overall spatial resolution, and difficult evaluation of the neural foramina, including the dorsal root ganglia (DRG). High resolution, 3-dimensional (3D) T2-weighted imaging of the cervical spine offers an opportunity to overcome many of these shortcomings. This education exhibit is meant to highlight the value of 3D volumetric T2-W imaging of the cervical spine with the SPACE sequence (Sampling Perfection with Application optimized Contrasts using different flip angle Evolution. Materials & Methods Highlights will include examples of the anatomy of the spinal canal and neural foramina and reduction of CSF flow artifact. Representative cases of post-hardware cervical spines will also be presented. Post-processed images of the cord using curved MPR and 3D rendering techniques will be included. Results LEARNING POINTS: 1. T2 SPACE imaging allows consistent visualization of individual nerve rootlets and congenital nerve variants, such as duplicated nerve rootlets or anomalous course of nerves. 2. Higher spatial resolution and isotropic voxels allow multiplanar evaluation of the spinal canal contents (i.e. nerve rootlets, disc herniations and associated nerve impingement, etc) without CSF flow artifact, which can have important clinical implications. 3. Neuroforaminal borders and configurations are better visualized and oblique reformatted images can be constructed to evaluate foraminal stenosis and contents. 4. Atlanto-axial anatomy and cervicocranial relationships are better evaluated, offering greater confidence in interpretation of pathology. 5. 3D reformatted images can produce MR myelographic images, without the need for intrathecal contrast injection. 6. Isotropic image acquisition allows segmentation of spinal cord and CSF volumes over targeted segments. 7. Minimal susceptibility artifact from spinal hardware allows visualization of the thecal sac contents at levels of prior instrumentation. 8. Cord signal changes can be visualized in similar fashion as on conventional T2 TSE/FSE images. Conclusion 3D T2 Imaging of the Cervical Spine offers an alternative to conventional spin echo imaging to better evaluate anatomy and pathology. References Gerigk L, Bostel T, Hegewald A, et al. Dynamic magnetic resonance imaging of the cervical spine with high-resolution 3-dimensional T2-imaging. Clin Neuroradiol. 2012 Mar;22(1):93-9. doi: 10.1007/s00062-011-0121-2. Epub 2011 Dec 23.