What information is required when ordering an MRI (Magnetic Resonance Imaging) of the spine?

Essential Information Required When Ordering a Spine MRI

When ordering an MRI of the spine, specific clinical information must be provided to ensure appropriate imaging protocols and accurate interpretation of results. The following information is essential for optimal spine MRI ordering:

Clinical Information Requirements

• Specific signs and symptoms must be clearly documented, including radicular pain patterns, neurological deficits, and functional limitations 1
• Duration of symptoms should be specified, particularly noting if symptoms have persisted beyond 6 weeks of conservative management 1, 2
• Neurological assessment documenting specific deficits corresponding to affected nerve roots and objective findings that correlate with subjective complaints 1
• Previous treatments attempted, including medications, physical therapy, and their outcomes 1, 2
• Red flags that may necessitate urgent imaging, such as:
  • Progressive neurological deficits 2, 1
  • Suspected cauda equina syndrome 2, 1
  • Fever or suspected infection 2
  • History of cancer, IV drug use, diabetes, HIV, or dialysis (for suspected infection) 2
  • Trauma 3

Anatomical Information Requirements

• Specific area of concern (cervical, thoracic, lumbar, or total spine) 2
• Targeted region based on clinical findings to avoid unnecessary total spine imaging 3
• Exact level(s) requiring evaluation and correlation between imaging findings and clinical presentation at specific level(s) 1

Technical Requirements and Special Considerations

• Need for contrast should be specified based on clinical suspicion:
  • Contrast is helpful when infection, inflammation, or tumor is suspected 2
  • Precontrast images are necessary when contrast is used to accurately assess enhancement 2
• Special positioning requirements if symptoms are position-dependent 4
• Skin abnormalities that may indicate underlying spinal dysraphism (hairy patches, skin discoloration, dimples, or draining sinuses) 2

Common Pitfalls to Avoid

• Ordering total spine MRI when localized imaging would suffice - Total spine MRIs represent a small but growing percentage of spine MRIs (increased from 4.85% in 2010 to 12.38% in 2021) and may lead to unnecessary follow-up imaging 3
• Failing to specify the need for contrast - Ordering MRI with contrast only, without precontrast images, limits diagnostic value 2
• Inadequate clinical information - Lack of specific symptoms and physical examination findings can lead to suboptimal protocol selection 1
• Not mentioning relevant patient history - History of cancer, infection risk factors, or previous spine surgery should always be included 2

Optimal MRI Protocols by Region

• Cervical spine: Sagittal T2 FSE, sagittal T1 SE, and axial 2D GE images 5
• Lumbar spine: Sagittal T2 weighted FSE, sagittal T1 weighted SE, and axial T2 weighted FSE sequences 5
• For bone marrow assessment: Addition of STIR sequence is recommended 5
• For suspected infection: MRI spine area of interest without and with IV contrast 2

By providing comprehensive clinical information when ordering spine MRIs, you can ensure appropriate imaging protocols are selected, leading to more accurate diagnosis and improved patient outcomes.