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Utility of Multidetector CT compared to MRI and Single Slice CT in the Evaluation of Cervical Spondylosis and Disc Disease 2005

General Spine

Reono - Bertagnolli, MD, Non ASSR Member
James P Eaton , MD, Non ASSR Member
Gregory W Petermann , MD, ASSR Member

Purpose

Multidetector CT (MDCT) has rapidly advanced CT imaging. We hypothesize that MDCT could be comparable to MRI and better than single slice CT for the evaluation of disc and spondolytic pathology in the cervical spine.

Methods & Materials

Forty total subjects were evaluated from C3-4 through C7-T1. Twenty subjects underwent MRI (GE 1.5T Signa excite 11.0) and single slice CT (GE Advantage CT) scan of the cervical spine from 2000 - 2003. Twenty different subjects underwent MRI and MDCT using either and 8 or 16 detector CT (GE lightspeed Ultra and lightspeed Ultra 16 respectively) of the cervical spine in 2004 - 2005. The presence or absence of spondolytic change or disc disease was tallied from 2 blinded neuroradiologists. Single slice CT images were obtained at 3mm intervals with sagittal reconstructions. MDCT images were obtained at 1.25 mm with either 1.25 mm or 0.625mm images for sagittal and coronal images. MRI consisted of sagittal T1, sagittal T2/PD, and axial 2D gradient recall and FSE T2 sequences at 3mm intervals.

Results

The images from the multidetector studies were far superior in the evaluation of disc pathology compared to the single slice images, and readily identified even small disc protrusions when correlated with the patients MRI studies. Single slice CT was adequate for bony endplate and uncovertebral changes, but was at times uninterpretable when evaluating the discs. The MRI studies were superior for spinal cord pathology, to include syringomyelia, cord gliosis from degenerative canal stenosis, and spinal cord tumors. The C7-T1 disc space was not well visualized on CT due to artifact. Newer protocols utilizing MDCT appear adequate in evaluating both bone and disc pathology of the cervical spine, but lacked adequate visualization of spinal cord abnormalities. Advantages of CT included improved visualization of degenerative hypertrophy and bone tumors. CT at our institution was less expensive, had faster throughput, less claustrophobia, and shorter scheduling times. CT disadvantages include radiation dose, lack of visualization of spinal cord, and poor diagnostic images at the C7-T1 disc space. The disadvantages of MRI include longer scheduling times, length of exam, cost, and motion artifact. In addition, MRI interpreters tended to overestimate the amount of bone hypertrophy and had difficulty differentiating bone from disc pathology.

Conclusion

Since disc protrusions and spondylosis are well seen on MDCT, non surgical patients without myelopathic symptoms could undergo MDCT with the knowledge that cord and C7-T1 abnormalities may not diagnosed. Limitations included lack of direct comparison of MDCT to single slice CT in same patients and the difference in slice thickness of the old vs. new CT images.