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Herniated Intervertebral Disc

J. Randy Jinkins¹, David D. Stark¹

¹Downstate Medical Center, State University of New York, Brooklyn, New York

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A8.1

DOI:

10.1002/0471142719.mia0801s05

Online Posting Date:

August, 2002

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Abstract

One of the most significant impacts of magnetic resonance imaging (MRI) has been its ability to exquisitely depict normal and pathologic anatomy of the spine. This unit presents a basic protocol for conventional fast spin echo imaging of the spine. An alternate protocol is presented for gradient recalled echo acquisitions that may be used in the sagittal and/or transverse planes to clearly distinguish between discs and soft tissue and to clarify the spinal neural foramen in the cervical region. A second alternate protocol is presented for contrast enhanced MRI acquisitions.

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Unit Introduction
Basic Protocol: Conventional and Fast Spin Echo
Alternate Protocol 1: Gradient Recalled Echo Sequences
Alternate Protocol 2: Contrast-Enhanced MRI Acquisitions
Commentary
Literature Cited
Figures
Tables

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Materials

Alternate Protocol 2: Contrast-Enhanced MRI Acquisitions

Materials

Normal sterile saline (0.9% NaCl)
Intravenous MRI contrast agent (e.g., Magnevist, Omniscan, or Prohance)

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Figures

Figure A8.1.1

Sagittal section showing allocation of transverse sections from midline sagittal section of lumbosacral spine. Note the anterior spatial saturation band (asterisks).

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Figure A8.1.2

Intervertebral disc herniation associated with enhancing radiculitis. (A) Sagittal T₂-weighted (T_R = 4000 msec, T_E = 90 msec) section shows a large L5-S1 posterior intervertebral disc herniation (arrow). (B) Transverse T₁-weighted (T_R = 500 msec, T_E = 10 msec) section at L5-S1 shows the disc herniation (asterisk) extending toward the right side. (C) Intravenous gadolinium–enhanced transverse T₁-weighted (T_R = 500 msec,T_E = 10 msec) section at L5-S1 shows several enhancing nerve roots (arrow) intrathecally.

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Literature Cited

Literature Cited
	Edelman, R.R., Shoukimas, G.M., Stark, D.D., et al. 1985. High-resolution surface coil imaging of lumbar disk disease. Am. J. Neuroradiol. 6:479-485.
	Hedberg, M.C., Drayer, B.P., Flom, A., Hodak, J.A., and Bird, C.R. 1988. Gradient echo (GRASS) MR imaging in cervical radiculopathy. Am. J. Neuroradiol. 9:145-151.
	Holtas, S., Nordstrom, C.-H., Larsson, E.-M., and Petterson, H. 1987. MR imaging of intradural disk herniation. J. Assist. Comput. Tomogr. 11:353-356.
	Jinkins, J.R. 1993a. Magnetic resonance imaging of benign nerve root enhancement in the unoperated and postoperative lumbosacral spine. Neuroimag. Clin. North Am. 3:525-541.
	Jinkins, J.R. 1993b. MR of enhancing nerve roots in the unoperated lumbosacral spine. Am. J. Neuroradiol. 14:193-202.
	Karnaze, M.G., Gado, M.H., Sartor, K.J., and Hodges, F.J.,III. 1987. Comparison of MR and CT myelography in imaging the cervical and thoracic spine. Am. J. Neuroradiol. 8:983-989.
	Masaryk, T.J., Ross, J.S., Modic, M.T., Boumphrey, F., Bohlman, H., and Wilber, G. 1988. High-resolution MR imaging of sequestered lumbar intervertebral disks. Am. J. Neuroradiol. 9:351-358.
	Modic, M.T., Pavlicek, W., Weinstein, M.A., Boumphrey, F., Ngo, F., Hardy, R., and Duchesneau, P.M. 1984. Magnetic resonance imaging of intervertebral disk disease. Radiology 152:103-111.
	Murayama, S., Numaguchi, Y., and Robinson, A.E. 1990. The diagnosis of herniated intervertebral disks with MR imaging: A comparison of gradient-refocused echo and spin-echo pulse sequences. Am. J. Neuroradiol. 11:17-22.
	Robertson, J.H., Meroni, R.M., Aprill, C.N., and Smith, R.D. 1991. CT and MRI scans in thoracic intradural disc herniation. Neuroradiology 33(S):331-332.
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	Ross, J.S., Modic, M.T., Masaryk, T.J., Carter, J., Marcus, R.E., and Bohlman, H. 1989. Assessment of extradural degenerative disease with Gd-dTPA enhanced MR imaging: Correlation with surgical and pathologic findings. Am. J. Neuroradiol. 10:11243-1249.
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	Tsruda, J.S., Norman, D., Dillon, W., Newton, T.H., and Mills, D.G. 1990. Three-dimensional gradient recalled MR imaging as a screening tool for the diagnosis of cervical radiculopathy. Am. J. Neurol. 10:1263-1271.
	Van Dyke, C., Ross, J.S., Tkach, I., Masaryk, T.J., and Modic, M.T. 1989. Gradient-echo MR imaging of the cervical spine: evaluation of extradural disease. Am. J. Neuroradiol. 10:627-632.
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