MRI for Diagnosis of Cervical Intervertebral Disc Syndrome
Yes, MRI is the most sensitive and appropriate imaging modality for diagnosing cervical intervertebral disc syndrome (IVDS), correctly identifying approximately 88% of disc lesions and nerve root compression. 1
Why MRI is the Preferred Modality
MRI is the most sensitive imaging modality for assessing soft tissue abnormalities of the cervical spine, including disc herniations, nerve root compression, and spinal cord involvement. 1 The American College of Radiology establishes MRI as superior to other modalities:
- MRI correctly predicts 88% of cervical disc lesions compared to 81% for CT myelography, 57% for plain myelography, and only 50% for CT alone. 1
- MRI provides excellent spatial resolution and intrinsic soft-tissue contrast for evaluating the spinal cord, nerve roots, disc spaces, and surrounding structures in multiple planes. 2
- MRI can detect disc abnormalities, nerve root compression, canal stenosis, and cord signal changes that are critical for diagnosis and surgical planning. 1
Recommended MRI Protocol
For suspected cervical IVDS without "red flag" symptoms, MRI cervical spine without IV contrast is the appropriate initial study. 1, 3
- Contrast is NOT routinely needed for degenerative disc disease evaluation. 1, 2
- Add IV contrast only if "red flags" are present, including suspected infection, known malignancy, or concern for epidural abscess. 2
- For postoperative patients, MRI without contrast is usually appropriate for detecting adjacent level disc disease and nerve impingement. 1
Critical Limitations and Pitfalls
MRI demonstrates frequent false-positive and false-negative findings that require careful clinical correlation. 1
- MRI is frequently positive in asymptomatic patients: degenerative disc changes occur in 17% of asymptomatic individuals in their twenties and 86-89% of those over 60 years. 4
- Abnormal MRI levels do not always correspond to clinical examination findings: in one study of 98 patients with cervical radiculopathy, agreement between pain location and MRI findings was poor. 1
- Only 73% of clinically affected nerve roots show compression on MRI, while 45% of patients show root compression without clinical symptoms. 5
- False-negative MRIs occur in 13-15% of cases, and 9-10% show only asymptomatic root compression. 5
Therefore, imaging findings MUST be correlated with clinical examination and symptoms - do not rely on MRI alone for diagnosis. 2, 3
When to Consider Alternative Imaging
CT myelography is an acceptable alternative when MRI is contraindicated or nondiagnostic. 1, 2
- CT myelography provides excellent visualization of the thecal sac, nerve roots, and bony structures at higher spatial resolution than MRI. 1
- Consider CT myelography for claustrophobic patients or when extensive hardware artifact limits MRI assessment. 1
- Be aware that myelography has documented procedural risks: 30% of patients report unexpected reactions and 14% experience maximum pain scores during the procedure. 1
Emerging Techniques
Newer MRI sequences and reconstructions are improving diagnostic accuracy by better visualizing osseous nerve root compression and increasing correlation with surgical findings. 1 Novel MRI signs for ruptured discs (blurred disc margins and mushroom-shaped discs) can increase diagnostic sensitivity from 35-45% to 95-97% for cervical ruptured discs. 6