MRI Exam-Specific Parameters: Spine Module (Revised 5-10-2022)

Katie Albus

Modified on: Fri, 13 Jan, 2023 at 3:46 PM

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.

The CSF on the axial bright fluid sequence must be bright or will result in a failure of the submission.
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	2D FSE or TSE are not acceptable Acceptable sequences include: 2D gradient echo, 3D FSE, 3D TSE and 3D gradient echo 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
4-15-2020	All	Clarified that the CSF on the axial bright fluid sequence must be bright or will result in a failure of the submission
5-10-2022	Cervical Spine	Axial bright fluid sequence: Added language about acceptable and not acceptable sequences

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