Cervical spine: three-dimensional MR imaging with magnetization transfer prepulsed turbo field echo techniques

A Histopathological Scheme for the Quantitative Scoring of Intervertebral Disc Degeneration and the Therapeutic Utility of Adult Mesenchymal Stem Cells for Intervertebral Disc Regeneration

The purpose of this study was to develop a quantitative histopathological scoring scheme to evaluate disc degeneration and regeneration using an ovine annular lesion model of experimental disc degeneration. Toluidine blue and Haematoxylin and Eosin (H&E) staining were used to evaluate cellular morphology: (i) disc structure/lesion morphology; (ii) proteoglycan depletion; (iii) cellular morphology; (iv) blood vessel in-growth; (v) cell influx into lesion; and (vi) cystic degeneration/chondroid metaplasia. Three study groups were examined: 5 × 5 mm lesion; 6 × 20 mm lesion; and 6 × 20 mm lesion plus mesenchymal stem cell (MSC) treatment. Lumbar intervertebral discs (IVDs) were scored under categories (i-vi) to provide a cumulative score, which underwent statistical analysis using STATA software. Focal proteoglycan depletion was associated with 5 × 5 mm annular rim lesions, bifurcations, annular delamellation, concentric and radial annular tears and an early influx of blood vessels and cells around remodeling lesions but the inner lesion did not heal. Similar features in 6 × 20 mm lesions occurred over a 3-6-month post operative period. MSCs induced a strong recovery in discal pathology with a reduction in cumulative histopathology degeneracy score from 15.2 to 2.7 (p = 0.001) over a three-month recovery period but no recovery in carrier injected discs.

Magnetization transfer ratio mapping of intervertebral disc degeneration

The magnetization transfer ratio of the lumbar discs was spatially quantified from age-matched subjects and the nucleus pulposus magnetization transfer ratio was correlated with T2-weighted Pfirrmann grades. A moderate and significant linear correlation between magnetization transfer ratio and Pfirrmann grades was observed, suggesting that nucleus pulposus collagen relative density increases with degeneration. High-resolution axial magnetization transfer ratio maps revealed elevated magnetization transfer ratio in the nucleus pulposa of injured and heavily degenerated discs. In the injured disc, significant elevation in nucleus pulposa magnetization transfer ratio was not accompanied by significant decrease in disc height. This observation may suggest a possible increase in absolute collagen content, in addition to increased collagen relative density. In summary, magnetization transfer MRI of the disc may serve as a noninvasive diagnostic tool for disc degeneration, in addition to other MRI techniques specific to proteoglycan content.

Myelographic MR imaging of the cervical spine with a 3D true fast imaging with steady-state precession technique: initial experience

The majority of spinal magnetic resonance (MR) imaging has been performed with spin-echo sequences and spoiled gradient-echo sequences. Advances in gradient MR imaging performance now permit imaging with coherent steady-state sequences. In this study, the authors compare a three-dimensional true fast imaging with steady-state precession sequence with a three-dimensional spoiled gradient-recalled-echo sequence for MR evaluation of the cervical spine in the transverse plane. Initial experience indicates that the steady-state sequence is superior to spoiled gradient-recalled-echo sequences for MR evaluation of cervical spine anatomy and abnormalities.

Comparison of two-dimensional gradient echo, turbo spin echo and two-dimensional turbo gradient spin echo sequences in MRI of the cervical spinal cord anatomy

The aim of this study was to assess the detectability and distinguishability of the cervical spinal cord, the anterior and posterior spinal roots and of the internal anatomy of the cord (distinction of grey and white matter). For this purpose 20 healthy volunteers were examined using a 1.5 T MR unit with 20 mT/m gradient strength and a dedicated circular polarized neck array coil. Three T2* weighted (w). 2D gradient echo sequences, two T2 w. 2D turbo spin echo (TSE) sequences and one T2 w. 2D turbo gradient spin echo (TGSE) sequence were compared. The multiecho 2D fast low angle shot (FLASH) sequence with magnetization transfer saturation pulse (me FLASH+MTS) yielded the best results for liquor/compact bone, liquor/spinal cord and grey/white matter contrast, as found with regions of interest (ROI) analysis. The single echo 2D FLASH sequence was significantly poorer than the two me FLASH+/-MTS sequences. Two-dimensional TGSE as well as 2D TSE with a 256 matrix and with a 512 matrix yielded the poorest results. In the visual analysis the contrast between liquor and compact bone, liquor and cord as well as liquor and roots was best with me FLASH+MTS, whereas grey/white matter distinction was best using me FLASH-MTS. In conclusion, we would therefore recommend the inclusion of an axial T2* w. multiecho 2D spoiled gradient echo sequence with magnetization transfer saturation pulse and gradient motion rephasing in a MR imaging protocol of the cervical spine.

MRI of the spine and spinal cord: imaging techniques, normal anatomy, artifacts, and pitfalls

BACKGROUND

Magnetic resonance imaging (MRI) is widely used to evaluate the spine and spinal cord.

OBJECTIVE

In this article, MRI of the spine is discussed in terms of normal anatomy, standard and advanced imaging techniques, general indications, limitations, and potential for the future.

DISCUSSION

Although MRI does not provide the high bony detail possible with computed tomography, the appropriate combination of the sequences takes advantage of the different tissue characteristics to discriminate the various bony-and soft-tissue structures of the spine.

CONCLUSION

MRI enables the imaging specialist to evaluate a large anatomic region in multiple planes and can better examine the spinal cord.

Cervical spondylosis: contrast-enhanced magnetization transfer prepulsed 3D turbo field echo MR imaging

Magnetic resonance (MR) imaging of the cervical spine with axial, low flip angle three-dimensional (3D) gradient-echo sequences is limited by long acquisition times and also by increased sensitivity to extrinsic and intrinsic magnetic field inhomogeneity, magnetic susceptibility differences, chemical shifts, and cerebrospinal fluid pulsatility. We attempted to assess the performance of gadolinium-enhanced, magnetization transfer (MT) prepulsed 3D fast gradient-echo sequences in demonstrating spondylotic changes of the cervical spine. Twenty patients with known cervical spine spondylosis were prospectively imaged in the axial plane using two gradient-echo-based MR techniques: 3D fast field echo (FFE) and gadolinium-enhanced, MT prepulsed, segmented turbo field echo (TFE). An average of 58 neural foramina on the 3D FFE images and 47 neural foramina on the contrast-enhanced TFE images were judged to be narrowed. The degree of neural foraminal narrowing was significantly less on the contrast-enhanced TFE images compared with the FFE images (P <0.001). Contrast-enhanced, MT prepulsed, segmented 3D TFE MR imaging has potential for ameliorating some of the limitations encountered in the more widely used gradient-echo techniques.