Revision History


In addition to the exam-specific instructions in the following tables, review the following information prior to examination selection and submission. Failure to follow the guidance below may result in failure of the submitted examination.

  • Failure to achieve bright fluid in axial sequence will result in fail of the submitted examination.

  • Failure to meet anatomic coverage and imaging plane specifications may result in failure.


Cervical Spine

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Sagittal dark fluid

  • CSF must be hypointense to the cord/nerve roots so that cord/nerve roots are well-defined

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • Must show good contrast between the cord and CSF

  • Should not be fat suppressed. The fat must be bright, but not so intense that it masks the fat/muscle plane

  • T1 FLAIR is acceptable for this

  • Must cover foramen magnum to T1

  • Must cover laterally through the neural foramina

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2

Sagittal bright fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hyperintense to the cord/nerve roots so that cord/nerve roots are well-defined

  • Fat must be bright, but not so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Must cover foramen magnum to T1

  • Must cover laterally through the neural foramina

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2

Axial bright fluid

(Recommendation is to consider GRE or 3D T2)
  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hyperintense to the cord/nerve roots so that cord/nerve roots are well-defined

  • Fat must be bright, but not so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Must cover contiguously from C3 to T1 (from C3 inferior endplate to T1 superior endplate)

  • Axial or oblique axials are acceptable

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2



Cervical Spine with Contrast for Intramedullary Disease

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Sagittal dark fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hypointense to the cord/nerve roots so that cord/nerve roots are well-defined

  • Should not be fat suppressed. The fat must be bright, but not so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • T1 FLAIR is acceptable for this sequence

  • Must cover foramen magnum to T1

  • Must cover laterally through the neural foramina

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2

Sagittal bright fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hyperintense to the cord/nerve roots so that cord/nerve roots are well-defined

  • Fat must not be so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Must cover foramen magnum to T1

  • Must cover laterally through the neural foramina

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2

Axial bright fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hyperintense to the cord/nerve roots so that cord/nerve roots are well-defined

  • Fat must not be so intense that it masks the fat/muscle plane

  • Must show good contrast between the grey and white matter

  • Must cover contiguously from C3 to T1 (from C3 inferior endplate to T1 superior endplate)

  • Axial or oblique axials are acceptable

  • Slice thickness ≤ 3.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2

Axial dark fluid post contrast

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hypointense to the cord/nerve roots so that cord/nerve roots are clearly-defined

  • Should not be fat suppressed, the fat must not be so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Must cover contiguously from foramen magnum to T1

  • Axial or oblique axials are acceptable

  • Slice thickness ≤ 3 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2

Sagittal dark fluid post contrast

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hypointense to the cord/nerve roots so that cord/nerve roots are clearly-defined

  • Should not be fat suppressed, the fat must not be so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Must cover foramen magnum to T1

  • Must cover laterally through the neural foramina

  • Slice thickness ≤ 3 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.0 mm2



Thoracic Spine

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Sagittal dark fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hypointense to the cord/nerve roots so that cord/nerve roots are well-defined

  • Should not be fat suppressed, the fat must be bright, but not so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • T1 FLAIR is acceptable for this sequence

  • Must cover C7 to L1 inclusive

  • Must cover laterally through the neural foramina

  • Slice thickness ≤ 4.0 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.6 mm2

Sagittal bright fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hyperintense to the cord/nerve roots so that cord/nerve roots are clearly-defined

  • Fat must not be so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Must cover C7 to L1 inclusive

  • Must cover laterally through the neural foramina

  • Slice thickness ≤ 4 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.6 mm2

Axial bright fluid, contiguous or angled

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hyperintense to the cord/nerve roots so that cord/nerve roots are clearly-defined

  • Fat must not be so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Axials may be angled or continuous

  • Axials or oblique axials are acceptable

  • Angled slices must cover at least 6 disc spaces

  • Angled slices must include at least 3 spaces per disc

  • Angled slices must include center slice through the disc space

  • Contiguous slices must cover at least 6 contiguous vertebrae (inclusive)

  • Slice thickness ≤ 4 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.6 mm2


Sagittal localizer

  • Must be able to number the vertebrae C2 through T6 and include landmarks on the localizer and at least one thoracic sagittal series that allows unambiguous labeling of the thoracic vertebrae

  • Landmarks may include a skin marker and/or sternal notch

  • Must include C2 through T12




Lumbar Spine

Required Sequences

Category A: 

Pulse Sequence and Image Contrast

Category B: 

Anatomic Coverage and Imaging Planes

Category C: 

Spatial Resolution

Sagittal dark fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hypointense to the cord/nerve roots so that cord/nerve roots are well-defined

  • Should not be fat suppressed, the fat must be bright, but not so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • T1 FLAIR is acceptable for this

  • Must cover T12 to S2 inclusive (in the sagittal lumbar sequences, T12 to S2 inclusive means from T12 superior endplate to S2 inferior endplate)

  • Must cover from and through one pedicle, all the way through to the contra-lateral pedicle, inclusive

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 1.5 mm

  • Pixel area ≤ 1.5 mm2

Sagittal bright fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • CSF must be hyperintense to the cord/nerve roots so that cord/nerve roots are clearly-defined

  • Fat must not be so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Must cover T12 to S2 inclusive (in the sagittal lumbar sequences, T12 to S2 inclusive means from T12 superior endplate to S2 inferior endplate)

  • Must cover from and through one pedicle, all the way through to the contra-lateral pedicle, inclusive

  • Slice thickness ≤ 5.0 mm

  • Gap ≤ 1.5 mm

  • Pixel area ≤ 1.5 mm2

Axial dark fluid and/or bright fluid

  • Should not have non-anatomic heterogeneous signal intensity of the cord

  • Dark fluid sequence: CSF must be hypointense to the cord/nerve roots so that cord/nerve roots are clearly-defined

  • Bright fluid sequence: CSF must be hyperintense to the cord/nerve roots so that cord/nerve roots are clearly-defined

  • Fat must not be so intense that it masks the fat/muscle plane

  • Must show good contrast between the cord and CSF

  • Must cover the L3-4, L4-5 and L5-S1 levels including each disc and contiguous endplates

  • Axial or oblique axials are acceptable

  • Slice thickness ≤ 4 mm

  • Gap ≤ 1.0 mm

  • Pixel area ≤ 1.5 mm2





Revision History for this Article

Date

Section

Description of Revision(s)

12-12-19

All

Article created; FAQs incorporated; No criteria changes




Previous: Exam-Specific Parameters: Head/Neck
Next: Exam-Specific Parameters: MSK