Lumbar Spine MRI

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Interpretation

Before doing anything, first verify patient identification and the date of scan

T1 Sagittals

In T1, spinal fluid is dark and fat is bright. Determine the left-right orientation. On the left, the gives off branches at ~L1. On the right, the renal artery runs posterior to IVC. The Aorta is wider than IVC.

Working from caudal to rostral observe:

• Neural foramina and nerve roots: nerve contact and compression.
• Intervertebral discs: width, protrusions/ herniations.
• Spinal column: alignment (spondylolisthesis), vertebral body shape (compression fractures, Schmorls’ nodes), posterior bony elements (spondylolysis), degenerative end plate changes (changes in fat content), hemangiomas.
• Retroperitoneal space: adenopathy, masses, great vessel aneurysm, etc

T2 Sagittals

In T2, spinal fluid is bright.

Working from caudal to rostral observe:

• Dural sac—cord and rootlets: width, compression, irregularities
• Intervertebral discs: width, protrusions/ herniations, hydration, high intensity zones
• Spinal column: alignment (spondylolisthesis), vertebral body shape (compression fractures, Schmorls’ nodes), posterior bony elements (spondylolysis), degenerative end plate changes (changes in fat content), hemangiomas.
• Posterior bony elements: breakage, listhesis, pseudo-articulations, etc.

T1 Axials

The CSF appears gray and fat appears bright. Proceed caudal to cranial.

Orientation – neural foramina lie at level of discs.

• Content of the spinal canal and neural foramina: Trace course of nerve roots through neural foramina
• Intervertebral discs— continuity, bulges, etc.
• Bone – Vertebral bodies; spondylolisthesis, posterior bony elements (spondylolysis, breakage)
• Ligamentam flavum: thickened appearance, impingement
• Retroperitoneal space: adenopathy, masses, muscle, etc.

T2 Axials

Spinal fluid appears bright. Proceed caudal to cranial.

• Content of the spinal canal and neural foramina: Trace course of nerve roots through neural foramina
• Intervertebral discs— continuity, bulges, etc.
• Bone – Vertebral bodies; spondylolisthesis, posterior bony elements (spondylolysis, breakage)
• Ligamentam flavum: thickened appearance, impingement
• Retroperitoneal space: adenopathy, masses, muscle, etc.

Assessment

Ensure you have covered all structures. Assess need for other studies

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,