What is the best imaging modality for evaluating a labral tear and cervical spine in a patient with a history of spinal reconstruction and potential hardware in the neck?

From the Guidelines

For imaging a labral tear and cervical spine in a patient with spinal reconstruction and possible hardware, I recommend starting with plain radiographs of the cervical spine to assess the hardware placement, followed by CT myelography for evaluating the cervical spine, as it is useful in patients with spinal hardware, as stated in the most recent study 1. This approach is based on the latest evidence from the American College of Radiology, which suggests that CT myelography may be useful in this setting, particularly when spinal hardware is present. The following steps should be considered:

• Obtain the patient's surgical records to understand exactly what hardware was placed and its composition, as some implants may be contraindicated for certain imaging modalities.
• Inform the radiologist about the hardware in advance so they can optimize the imaging protocols to minimize artifacts.
• For the labral tear, MR arthrography would provide the most detailed assessment, as it involves injecting contrast directly into the joint for better visualization of labral pathology.
• The patient should be prepared for the possibility that multiple imaging modalities may be needed to get a complete diagnostic picture due to the challenges presented by the spinal hardware. Key considerations include:
• The presence of spinal hardware may create significant artifacts on MRI, potentially obscuring important findings.
• Metal artifact reduction sequences (MARS) can be employed during MRI to improve image quality around the hardware, but CT myelography is preferred in this case due to its usefulness in patients with spinal hardware, as supported by the latest study 1.

From the Research

Imaging Modalities for Labral Tear and Cervical Spine

• For imaging a labral tear, MR arthrography has been shown to be the most sensitive technique for detecting labral tears and degeneration, as well as detached labral fragments 2.
• In the context of hip imaging, MR arthrography has also been found to be superior to conventional MRI for detecting labral tears and acetabular cartilage defects, with higher interobserver agreement 3.
• For cervical spine imaging, particularly in patients with spinal reconstruction and potential hardware in the neck, CT scans can be useful for evaluating bone destruction and hardware placement, while MRI enables the assessment of tissue characteristics and tumor extent 4.
• However, the presence of hardware in the neck may limit the use of certain imaging modalities, such as MRI, due to artifacts or compatibility issues.
• In such cases, CT scans with or without contrast may be a suitable alternative for evaluating the cervical spine and surrounding soft tissues 5.

Considerations for Imaging with Hardware

• When imaging a patient with spinal reconstruction and hardware in the neck, it is essential to consider the type of hardware and its compatibility with the chosen imaging modality.
• MRI may not be suitable for patients with certain types of hardware, such as ferromagnetic materials, due to the risk of artifact or hardware displacement.
• CT scans, on the other hand, can provide detailed images of bone and hardware, but may not offer the same level of soft tissue detail as MRI.
• The choice of imaging modality ultimately depends on the specific clinical question and the patient's individual circumstances, and should be made in consultation with a radiologist or other qualified healthcare professional 6.