Should a c-spine (cervical spine) MRI include contrast?

From the Guidelines

A cervical spine MRI typically does not require contrast unless specific conditions are being evaluated, such as infections, tumors, inflammatory processes, or post-surgical changes, as stated in the most recent and highest quality study 1. When evaluating patients with suspected spine infection, MRI without and with IV contrast has a sensitivity of 96% and a specificity of 94% 1. The use of IV contrast helps to identify abnormal epidural fluid collections, define their size and extent, and determine the presence of spinal cord and/or cauda equina compression 1. However, for routine evaluation of disc herniations, spinal stenosis, or degenerative changes, a non-contrast MRI is usually sufficient and preferred. Some key points to consider when deciding whether to use contrast in a cervical spine MRI include:

• The clinical question being addressed, such as suspected infection or tumor
• The presence of specific conditions that may require contrast, such as post-surgical changes or inflammatory processes
• The potential risks associated with contrast, including allergic reactions and concerns about gadolinium deposition in tissues, particularly in patients with kidney dysfunction
• The input of the radiologist, who can provide guidance on the necessity of contrast based on the specific clinical scenario. In general, the decision to use contrast should be made on a case-by-case basis, taking into account the individual patient's needs and the specific clinical question being addressed, as recommended by the most recent study 1.

From the FDA Drug Label

Gadoteridol was evaluated in a multicenter study of 103 patients undergoing brain or spine MRI. Among these patients, the age range was 2 to 20 years; 54 were between 2 and 12 years of age; 74% were Caucasian, 11% Black, 12% Hispanic, 2% Asian, and 2% other. Gadoteridol was given in one single 0. 1 mmol/kg dose. Repeat dosing was not studied. The results of the non-contrast and gadoteridol MRI scans were compared. In this database, MRI enhancement was noted in approximately 60% of the scans and additional diagnostic information in 30 to 95% of the scans.

The use of contrast in a c-spine MRI may be beneficial as it can provide additional diagnostic information in a significant percentage of scans. According to the study, MRI enhancement was noted in approximately 60% of the scans and additional diagnostic information in 30 to 95% of the scans 2. However, the decision to use contrast should be made on a case-by-case basis, considering the individual patient's condition and the specific diagnostic question being addressed.

• Key points:
  • Contrast may provide additional diagnostic information
  • Decision to use contrast should be made on a case-by-case basis
  • Consider individual patient's condition and diagnostic question being addressed
• Main idea: The use of contrast in c-spine MRI can be beneficial, but should be decided based on individual patient needs.

From the Research

C-Spine MRI with Contrast

The decision to use contrast in a c-spine MRI depends on the specific clinical scenario. Here are some points to consider:

• The use of contrast in c-spine MRI is not always necessary, as noncontrast MRI can detect many types of injuries and conditions, such as hematoma, edema, and spinal stenosis 3.
• However, contrast-enhanced MRI is more sensitive in detecting soft tissue injuries, and its use is recommended in cases where such injuries are suspected 3.
• The optimal protocols and role of contrast agents in spinal MR imaging are controversial, and the decision to use contrast should be tailored to the specific clinical scenario and the location and site of origin of the lesions in a specific spinal compartment 4.
• MRI with contrast can be useful in evaluating intraspinal neoplasms, spinal cord parenchymal lesions, infections, congenital abnormalities, and postoperative failed back syndromes 5.
• In cases where patients are unexaminable or symptomatic with normal CT scan findings, c-spine MRI with contrast can detect injuries that may not be visible on CT scans, and can alter treatment plans 6.

Specific Considerations

• The pattern of contrast enhancement can vary depending on the dose of gadolinium used, and triple-dose gadolinium may increase vascular and nerve root enhancement 7.
• The use of contrast agents in pediatric patients should be carefully considered, as the patterns of contrast enhancement in the pediatric spine can be different from those in adults 7.
• In general, the decision to use contrast in a c-spine MRI should be based on the specific clinical scenario, and should take into account the potential benefits and risks of contrast administration, as well as the availability of alternative imaging modalities 3, 5, 4, 6, 7.