Magnetic resonance imaging (MRI) of the spine is a noninvasive procedure to evaluate different types of tissue, including the spinal cord, vertebral disks and spaces between the vertebrae through which the nerves travel, as well as distinguish healthy tissue from diseased tissue.
The cervical, thoracic and lumbar spine MRI should be scanned in individual sections. The scan protocol parameter like e.g. the field of view (FOV), slice thickness and matrix are usually different for cervical, thoracic and lumbar spine MRI, but the method is similar. The standard views in the basic spinal MRI scan to create detailed slices (cross sections) are sagittal T1 weighted and T2 weighted images over the whole body part, and transverse (e.g. multi angle oblique) over the region of interest with different pulse sequences according to the result of the sagittal slices. Additional views or different types of pulse sequences like fat suppression, fluid attenuation inversion recovery (FLAIR) or diffusion weighted imaging are created dependent on the indication.

Indications:

Contrast enhanced MRI techniques delineate infections vs. malignancies, show a syrinx cavity and support to differentiate the postoperative conditions. After surgery for disk disease, significant fibrosis can occur in the spine. This scarring can mimic residual disk herniation. Magnetic resonance myelography evaluates spinal stenosis and various intervertebral discs can be imaged with multi angle oblique techniques. Cine series can be used to show true range of motion studies of parts of the spine. Advanced open MRI devices are developed to perform positional scans in the position of pain or symptom (e.g. Upright™ MRI formerly Stand-Up MRI).

MRI of the lumbar spine, with its multiplanar 3 dimensional imaging capability, is currently the preferred modality for establishing a diagnosis. MRI scans and magnetic resonance myelography have many advantages compared with computed tomography and/or X-ray myelography in evaluating the lumbar spine. MR imaging scans large areas of the spine without ionizing radiation, is noninvasive, not affected by bone artifacts, provides vascular imaging capability, and makes use of safer contrast agents (gadolinium chelate).
Due to the high level of tissue contrast resolution, nerves and discs are clearly visible. MRI is excellent for detecting degenerative disease in the spine. Lumbar spine MRI accurately shows disc disease (prolapsed disc or slipped disc), the level at which disc disease occurs, and if a disc is compressing spinal nerves. Lumbar spine MRI depicts soft tissues, including the cauda equina, spinal cord, ligaments, epidural fat, subarachnoid space, and intervertebral discs. Loss of epidural fat on T1 weighted images, loss of cerebrospinal fluid signal around the dural sac on T2 weighted images and degenerative disc disease are common features of lumbar stenosis.

Common indications for MRI of the lumbar spine:
Lumbar spine imaging requires a special spine coil. often used whole spine array coils have the advantage that patients do not need other positioning if also upper parts of the spine should be scanned. Sagittal T1 and T2 weighted FSE sequences are the standard views. With multi angle oblique techniques individually oriented transverse images of each intervertebral disc at different angles can be obtained.

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Cervical spine MRI is a suitable tool in the assessment of all cervical spine (vertebrae C1 - C7) segments (computed tomography (CT) images may be unsatisfactory close to the thoracic spine due to shoulder artifacts). The cervical spine is particularly susceptible to degenerative problems caused by the complex anatomy and its large range of motion.
Advantages of magnetic resonance imaging MRI are the high soft tissue contrast (particularly important in diagnostics of the spinal cord), the ability to display the entire spine in sagittal views and the capacity of 3D visualization. Magnetic resonance myelography is a useful supplement to conventional MRI examinations in the investigation of cervical stenosis. Myelographic sequences result in MR images with high contrast that are similar in appearance to conventional myelograms. Additionally, open MRI studies provide the possibility of weight-bearing MRI scan to evaluate structural positional and kinetic changes of the cervical spine.
Indications of cervical spine MRI scans include the assessment of soft disc herniations, suspicion of disc hernia recurrence after operation, cervical spondylosis, osteophytes, joint arthrosis, spinal canal lesions (tumors, multiple sclerosis, etc.), bone diseases (infection, inflammation, tumoral infiltration) and paravertebral spaces.
State-of-the-art phased array spine coils and high performance MRI machines provide high image quality and short scan time. Imaging protocols for the cervical spine includes sagittal T1 weighted and T2 weighted sequences with 3-4 mm slice thickness and axial slices; usually contiguous from C2 through T1. Additionally, T2 fat suppressed and T1 post contrast images are often useful in spine imaging.

See also Lumbar Spine MRI.

The multi angle oblique technique gives the ability to display anatomical structures in a variety of planes from the data acquired in just one MRI scan. This technique is useful, for example in lumbar spine MRI obtaining images of each intervertebral disc, individually oriented at a different angle, to better recognize herniation or to compare degenerative changes.
This technique is more difficult in the cervical spine MRI region because of the small vertebra and therefore a short distance between the multi angle oblique planes. In case of too short distance or overlapping slices the crosstalk (artifact) destroys the signal with reduced image quality.

Contrast enhanced MRI is a commonly used procedure in magnetic resonance imaging. The need to more accurately characterize different types of lesions and to detect all malignant lesions is the main reason for the use of intravenous contrast agents.
Some methods are available to improve the contrast of different tissues. The focus of dynamic contrast enhanced MRI (DCE-MRI) is on contrast kinetics with demands for spatial resolution dependent on the application. DCE-MR imaging is used for diagnosis of cancer (see also liver imaging, abdominal imaging, breast MRI, dynamic scanning) as well as for diagnosis of cardiac infarction (see perfusion imaging, cardiac MRI). Quantitative DCE-MRI requires special data acquisition techniques and analysis software.
Contrast enhanced magnetic resonance angiography (CE-MRA) allows the visualization of vessels and the temporal resolution provides a separation of arteries and veins. These methods share the need for acquisition methods with high temporal and spatial resolution.
Double contrast administration (combined contrast enhanced (CCE) MRI) uses two contrast agents with complementary mechanisms e.g., superparamagnetic iron oxide to darken the background liver and gadolinium to brighten the vessels. A variety of different categories of contrast agents are currently available for clinical use.
Reasons for the use of contrast agents in MRI scans are:
Common Indications:
Brain MRI : Preoperative/pretreatment evaluation and postoperative evaluation of brain tumor therapy, CNS infections, noninfectious inflammatory disease and meningeal disease.
Spine MRI : Infection/inflammatory disease, primary tumors, drop metastases, initial evaluation of syrinx, postoperative evaluation of the lumbar spine: disk vs. scar.
Breast MRI : Detection of breast cancer in case of dense breasts, implants, malignant lymph nodes, or scarring after treatment for breast cancer, diagnosis of a suspicious breast lesion in order to avoid biopsy.

For Ultrasound Imaging (USI) see Contrast Enhanced Ultrasound at Medical-Ultrasound-Imaging.com. See also Blood Pool Agents, Myocardial Late Enhancement, Cardiovascular Imaging, Contrast Enhanced MR Venography, Contrast Resolution, Dynamic Scanning, Lung Imaging, Hepatobiliary Contrast Agents, Contrast Medium and MRI Guided Biopsy.