Introduction Magnetic Resonance Imaging (MRI) has become an indispensable tool in the diagnosis and management of spinal disorders.¹ This text aims to provide an overview of common findings in spine MRI and introduce advanced imaging modalities such as MR neurography and muscle imaging. It also addresses the importance of interdisciplinary collaboration and the use of standardized nomenclature to describe imaging findings. Identifying clinically relevant pathologies in spine MRI is crucial for guiding effective patient management and treatment strategies. Certain common conditions such as acute bone fractures, spinal canal stenosis and spinal nerve root compressions, have significant implications for patient outcomes and require prompt and accurate diagnosis.

Common Findings in Spine MRI One of the most frequently encountered conditions in spine MRI is degenerative disc disease (DDD).² Characterized by the deterioration of intervertebral discs, DDD often presents with disc desiccation, decreased disc height, and disc bulging. These changes are typically associated with aging but can also be accelerated by mechanical stress and genetic factors. Bone marrow edema (BME) is a key indicator of underlying pathology in the spine, often associated with acute trauma, inflammatory conditions, or degenerative changes. It appears as hyperintense areas on T2-weighted and STIR images. Recognizing BME is essential because it may signify conditions such as vertebral fractures and osteitis, which necessitate targeted interventions to prevent further complications. Spinal fractures can result from trauma, osteoporosis, or pathological processes such as metastatic disease. MRI is superior to other imaging modalities in detecting acute fractures, particularly in cases where conventional radiographs may be inconclusive. Disc herniation is a common finding, where the nucleus pulposus protrudes through a tear in the annulus fibrosus. Spinal nerve root compressions are common in conditions such as herniated discs, spinal stenosis, and foraminal narrowing. These compressions can lead to radiculopathy, characterized by pain, weakness, or sensory deficits along the affected nerve’s distribution. MRI provides detailed visualization of nerve roots and their surrounding structures, enabling precise localization of compression sites. This information is vital for planning surgical decompression or other therapeutic measures aimed at relieving symptoms and preventing long-term neurological deficits. Spinal stenosis involves the narrowing of the spinal canal, which can compress the spinal cord or nerve roots. This condition is often seen in the cervical and lumbar spine as a consequence of degenerative changes, such as hypertrophy of the ligamentum flavum or spondylophyte formation. MRI helps in evaluating the degree of stenosis and planning appropriate intervention strategies. Spondylolisthesis refers to the displacement of one vertebra over another, which can cause significant spinal instability and pain. Radiographs, computed tomography, and MRI aid in assessing the alignment of the vertebrae, the integrity of the intervertebral discs, and any involvement of the spinal cord or nerve roots.

Advancements in Spine Imaging MR Neurography

Brachial, lumbar, and lumbosacral MR neurography represents a significant advancement in the imaging of the spine.^{3 4} Utilizing high-resolution MR neurography techniques, this imaging method allows for detailed visualization of the nerves, which is often involved in conditions such as trauma, inflammation, or neoplastic infiltration. Advanced techniques provide insights into nerve integrity and pathology that were previously unattainable. Additionally, recent advancements in MRI have also enhanced our ability to image large muscle groups. Muscle denervation changes, atrophy and fatty infiltration, which are common in acute and chronic spinal conditions, can now be quantified using advanced imaging sequences. Personalized MRI protocols, tailored to address these specialty-specific questions, can significantly enhance patient care.

Challenges in Interdisciplinary Work and the Importance of Common Nomenclature Interdisciplinary collaboration is essential in the management of spinal disorders, involving radiologists, orthopedic surgeons, pain therapists, neurologists, physiotherapists, and other healthcare professionals. However, this collaboration brings challenges, primarily due to differences in terminology and expectations across specialties. The use of a common nomenclature is vital to ensure clear communication and effective treatment planning.⁵ To characterize lumbar disc morphology and pathology, the NASS nomenclature was introduced in 2014 and has been in widespread use since.⁶ This common language can facilitate better interdisciplinary communication. The NASS nomenclature provides clear definitions for terms like disc bulge, protrusion, extrusion, and sequestration. By adopting such standardized terms, radiologists can provide reports that are easily understood by all members of the treatment team, reducing the risk of miscommunication and ensuring that each specialist receives the precise information needed for their role.

Conclusion Spine MRI interpretation remains a cornerstone in the diagnosis and management of spinal disorders. Familiarity with common findings such as degenerative disc disease, disc herniation and its nomenclature, spinal stenosis, and spondylolisthesis is essential for accurate diagnosis and treatment planning. Advancements in imaging techniques, particularly MR neurography and muscle imaging, are expanding our diagnostic capabilities and enhancing our understanding of spinal pathologies. Personalized MRI protocols tailored to address the clinicians’ needs promise to improve outcomes by providing precise and relevant information to all members of the healthcare team.

References

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