From the Guidelines
A 1.5 Tesla upright MRI is generally sufficient to evaluate for craniocervical instability, particularly when used in conjunction with dynamic imaging and specific sequences to assess the craniocervical junction in a weight-bearing position. This approach is supported by the most recent guidelines, which emphasize the importance of MRI in assessing neurologic injury in the setting of spine trauma, especially when there is concern for ligament injury or in screening obtunded patients for cervical spine instability 1. The use of upright MRI allows for the evaluation of the craniocervical junction while the patient is in a weight-bearing position, which can reveal abnormalities that might not be apparent on conventional supine MRI.
Key Considerations
- The 1.5 Tesla magnetic field strength provides sufficient resolution to visualize the key structures involved, including the atlantoaxial joint, odontoid process, and surrounding ligaments.
- Specific sequences should be performed, including sagittal and coronal T1 and T2-weighted images, as well as flexion and extension views to assess for abnormal movement.
- Dynamic imaging during these position changes is especially important for detecting instability.
- While higher field strength MRIs (3T) may offer slightly better resolution, the positional advantage of the upright MRI often outweighs this benefit when specifically looking for craniocervical instability.
Evidence-Based Recommendations
- MRI is preferred to CT myelography for assessing neurologic injury in the setting of spine trauma 1.
- MRI is usually appropriate when there is concern for ligament injury or in screening obtunded patients for cervical spine instability 1.
- The correlation of MRI findings with acknowledged standards is often poor, and the significance of many MRI abnormalities is unknown, highlighting the need for careful interpretation of results in the context of clinical presentation 1.
From the Research
Evaluation of Craniocervical Instability using Upright MRI 1.5 Tesla
- The use of upright MRI 1.5 Tesla for evaluating craniocervical instability has been explored in various studies 2, 3, 4, 5, 6.
- A study published in 2021 found that MRI clearly described several findings indicating occipitoatlantal instability, and that it was more reliable than CT scans in demonstrating C1/2 facet injury and/or cruciate ligament injury 2.
- Another study published in 2010 found that MRI evaluation was performed in all patients with suspected craniocervical dissociation, and that it helped to identify the injury and guide treatment 3.
- A 2024 study analyzed the variance of normative supine and upright imaging in a healthy population and found that understanding normal variance in cervical measurements is invaluable for accurate craniocervical instability diagnosis 4.
- A 2011 study used upright multi-position MR scanning to uncover a key set of new observations regarding multiple sclerosis, including pronounced anatomic pathology of the cervical spine in MS patients, which was visualized by upright MRI 5.
- A 2018 case report described a patient with Chiari I malformation who developed acute neurological deficit after craniocervical trauma, and highlighted the importance of prompt recognition and treatment of craniocervical instability 6.
Key Findings
- Upright MRI 1.5 Tesla can be used to evaluate craniocervical instability and identify findings such as occipitoatlantal instability, C1/2 facet injury, and/or cruciate ligament injury 2, 3.
- Upright MRI can provide more reliable results than CT scans in demonstrating cervical spine injuries 2.
- Understanding normal variance in cervical measurements is important for accurate diagnosis of craniocervical instability 4.
- Upright MRI can be used to visualize anatomic pathology of the cervical spine in patients with multiple sclerosis 5.
- Prompt recognition and treatment of craniocervical instability is essential in patients with Chiari I malformation who develop acute neurological deficit after craniocervical trauma 6.