Basic Lumbal Spine MRI

MRI of Spinal Cord

Non-invasive
Provides anatomic detail of
spinal cord, intravertebral disc
spaces,
and
CSF
within
subarachnoid space
Does not require intrathecal
injection

CONTRAINDICATIONS TO MRI
There are few contraindications to MRI. Most contraindications to MRI can be
divided into the following groups:
Implanted devices and other metallic devices
- Pacemakers and other implanted electronic devices
- Aneurysm clips and other magnetizable materials
- Cochlear implants
- Some artificial heart valves
Intraocular metallic foreign bodies
- Screening CT of the orbits if history suggests possible metallic foreign body
in the eye
Unstable patients (most resuscitation equipment cannot be brought into
the scanning room)
Pregnancy (relative contraindication due to unknown effects on the fetus)
Other severe agitation, or claustrophobia (may require anesthesia
assistance)

Usefulness of MRI
Assessing
demyelinating
disease
Such as MS

Spinal cord
compression
Post radiation
therapy changes of
spinal cord tumors

Herniated disks
Congenital
abnormalities of
vertebral column
Metastatic disease
Para spinal masses

TR and TE

TE (echo time) : time interval in which signals are measured after RF excitation
TR (repetition time) : the time between two excitations is called repetition time
By varying the TR and TE one can obtain T1WI and T2WI
In general a short TR (<1000ms) and short TE (<45 ms) scan is T1WI
Long TR (>2000ms) and long TE (>45ms) scan is T2WI
Single shot TR 8000 ms, TE 1000 ms is MR Myelography

CT- LUMBAR SPINE

POST MYELOGRAM

Axial

PEDICLE

PEDICLE

NERVE ROOTS

CT-LUMBAR SPINE
POST MYELOGRAM

THECAL SAC

LAMINA

LAMINA

CT- LUMBAR
SPINE
POST
MYELOGRAM

FACET JOINTS

What is T1 sequence..
T1 refers to time
taken for return of
magnetization.
FLUID IS BLACK on T1.

T1 image of spine

MRI lumbar T1WI

T1-weighted axial of the L5 disc..

Spinous process (SP)
the lamina (LAM)
the facet joint (white): superior articular
process of the sacrum (SAP) , inferior
articular process (IAP).
TS: thecal sac
two ears (green): tranversing S1 nerve
roots which dive down into the sacrum
and exit through the sacral foramen.
Dorsal root ganglia in purple (DRG).

MRI LUMBAR SPINE

NERVE ROOTS

FORAMEN

AXIAL VIEW

MRI LUMBAR SPINE

AXIAL VIEW
DISC
FACET JOINTS

LAMINA

MRI LUMBAR SPINE

THECAL SAC
NERVE
ROOTS

AXIAL VIEW

What is T2 sequence..
T2 image of spine
T2 refers to loss of
transverse
magnetization.
FLUID IS BRIGHT on
T2

MRI Lumbar spine T2WI

ANATOMY AXIAL

Axial section at L4-L5 disc

level , shows L4 root exiting out
of neural foramen , L5 root at
lateral recess

Axial section at vertebral body

level , shows pedicles , nerve
roots in cauda equina

MR-Myelography

Comparison of T1 vs T2 (Spine)

Fluid-Attenuated Inversion
Recovery FLAIR
Basically T2 without
CSF brightness
TE>80 and
TR>10,000
Edema and Gliosis
are hyperintense

GRADATION OF INTENSITY
IMAGING

CT SCAN

CSF

Edema

White
Matter

Gray
Matter

Blood

Bone

MRI T1

CSF

Edema

Gray
Matter

White
Matter

Cartilage Fat

MRI T2

Cartilag
e

Fat

White
Matter

Gray
Matter

Edema

CSF

MRI T2
Flair

CSF

Cartilage Fat

White
Matter

Gray
Matter

Edema

1)
2)
3)
4)

Bone marrow contains fat so appear

bright in T1 and darker in T2 WI
Thrombus = Subacute blood so
appear white in T1 & White T2 WIs
Normal flowing blood gives no signal
so appear Black in T1, Black in T2
Intervertebral disc: Nucleus pulposus
(contains water) black in T1, white
T2, Annulus fibrosus (mature fibrous
tissue) black in T1, black in T2

Which scan best defines the abnormality

T1 W Images:
Subacute Hemorrhage
Fat-containing structures
Anatomical Details
T2 W Images:
Edema
Demyelination
Infarction
Chronic Hemorrhage
FLAIR Images:
Edema,
Demyelination
Infarction esp. in Periventricular location

MRI- LUMBAR SPINE

SAGITTAL

L-3 L-4
DISC
L-4 - L-5
DISC

L5
S1

MRM
demonstrated
the most
severe stenotic
level. The
L3/4, shows a
longer total
block area
(bidirectional
arrow) than
the L2/3 level
with a dilated
intradural
(arrow).

J Korean Orthop Assoc. 2007 Dec;42(6):781-788

A postero-central disc herniation

is seen at L4/5 with mild
ligamentum flavum thickening
causing compression of the
thecal sac and both L5 nerve
roots.
MRI myelogram images in the
sagittal and coronal planes show
thecal sac and nerve root
compression at L4/5, which
increases on the stress study.

Than
k
you