From the Guidelines
No, you do not need an MRI with contrast to evaluate cervical radiculopathy or fracture. For suspected cervical radiculopathy, a non-contrast MRI is typically sufficient to visualize nerve root compression, disc herniations, and spinal stenosis, as it provides superior intrinsic soft-tissue contrast and good spatial resolution 1. For fractures, a CT scan is actually the preferred initial imaging modality due to its superior ability to visualize bone detail. Contrast (gadolinium) is only necessary in specific situations such as when evaluating for infection, inflammation, tumors, or post-surgical changes, as stated in the ACR Appropriateness Criteria for cervical neck pain or cervical radiculopathy 1. Using contrast adds unnecessary cost and potential risks (including allergic reactions and concerns about gadolinium deposition) without providing additional diagnostic value for straightforward radiculopathy or fracture evaluation.
Some key points to consider:
- Non-contrast MRI is usually appropriate for assessment of new or increasing radiculopathy due to improved nerve root definition 1.
- MRI without and with contrast is usually appropriate in patients with new or increasing cervical or neck pain or radiculopathy in the setting of suspected infection or known malignancy 1.
- CT myelography may prove useful in diagnosing foraminal stenosis, bony lesions, and nerve root compression, and can be considered in patients with clinically apparent radiculopathy and contraindication to MRI, or in the setting of equivocal MRI findings 1.
If the initial non-contrast imaging is inconclusive or if there are concerns for more complex pathology like infection or malignancy, then contrast-enhanced MRI could be considered as a second-line investigation.
From the Research
Evaluation of Cervical Radiculopathy or Fracture
To evaluate cervical radiculopathy or fracture, various diagnostic methods can be employed. The primary goal is to accurately identify the cause and severity of the condition.
Diagnostic Methods
- MRI without Contrast: Studies have shown that MRI can be an effective tool in diagnosing cervical radiculopathy caused by a herniated cervical disc 2, 3, 4, 5.
- MRI with Contrast: The use of contrast-enhanced MRI or MDCT can provide detailed information about the severity and cause of neural foraminal stenosis in patients with cervical radiculopathy 6.
- Physical Examination and History: A thorough physical examination and patient history are essential in suggesting the diagnosis of cervical radiculopathy, which can be confirmed with imaging studies like MRI 3.
Role of Contrast in MRI
- The study by 6 found that contrast-enhanced MDCT and MRI have similar accuracies in evaluating the severity and cause of neural foraminal stenosis.
- However, the decision to use contrast in MRI for evaluating cervical radiculopathy or fracture should be based on the specific clinical scenario and the information needed for diagnosis and treatment planning.