Ezio Fanucci MD, Abstract Co-Author: Nothing to Disclose

Guglielmo Manenti MD, Presenter: Nothing to Disclose

Valeria Fiaschetti, Abstract Co-Author: Nothing to Disclose

Francesca Della Gatta, Abstract Co-Author: Nothing to Disclose

Giovanni Simonetti MD, Abstract Co-Author: Nothing to Disclose

To determine if adding to traditional supine MRI views, neutral, flexion and extension MRI data in standing position would be beneficial in the evaluation of cervical disc bulges.

23 Patients with radicular cervical spine signs and symptoms underwent pMRI in neutral (standing position and traditional supine position) , flexion, and extension. Disc bulge was measured as the amount of extension of the disc beyond the intervertebral space from vertebral body. Discs with less than 2.0 mm disc bulge in the neutral supine position were selected and compared with their respective standing position, flexion and extension data.MR examinations were performed with a permanent open magnet with changeable position and static 0.25 T field, dynamic gradients with 20 mT/m power and 25 mT/m/sec slew rate (G-SCAN, Esaote, Italia). The data obtained from the MR images were recorded on a computer for subsequent calculations, which were performed using an MRI analyzer. Sagittal MR images were analyzed in four positions. Disc bulge was measured using reconstruction console  to objectively quantify the amount of disc bulge in millimetres from vertebral body to obliteration of the subarachnoid space. The statistical significance was calculated using the chi-square test.  

The increment of disc bulge less than 2.0 mm in recumbent position , was as following: 25.% in standing position, 18.% in flexion and 23% in extension (p=0.024). In addition, the increment of disc bulge less between 2.0 and 3 mm in recumbent position was: 36% in standing position, 23% in flexion and 33% in extension (p=0.32). Using 2.0 mm of disc bulge as a cutoff value, the false negative ratio for the neutral position alone compared to standing position, flexion and extension was 25%.

A significant increase in the degree of cervical disc bulge was found by examining standing position views as compared to neutral supine position views alone. Standing position has a higher detection rate of missed cervical disc bulges than neutral supine position as extension MRI views yield has a higher detection rate of missed cervical disc bulges than flexion views.

Flexion and extension MRI views provide valuable, added information when assessing patients for cervical disc bulge.

Fanucci, E, Manenti, G, Fiaschetti, V, Della Gatta, F, Simonetti, G, Cervical MRI in Standing Position, Flexion-Extension by Open Configuration Low-field Tilting MR System: Assessment of Cervical Disc Bulge.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034616.html