Resources/Protocols
Spine MRI protocols
Alignment discipline and level-labelling accuracy matter more here than anywhere else in MRI — a mislabelled level can change a surgical plan.
Spine work rewards methodical planning. The sagittal stack defines the exam, axial groups are angled per disc space rather than as one block, and every image must be traceable to a correctly counted vertebral level. Get counting and angulation right and the rest of the protocol is routine.
Deep-dive protocol guides
Full step-by-step protocols — positioning, per-sequence planning, parameters, artifacts and a review checklist for each study:
Studies in this region
- Craniovertebral junction
- Cervical spine
- Cervical dynamic
- Cervicodorsal
- Dorsal spine
- Dorso-lumbar
- Lumbar spine
- Lumbar dynamic
- Whole-spine screening
- Brachial plexus
- Lumbar plexus
- Sacral plexus
- Sacrum & coccyx
- SI joints
- MR myelography
- Contrast spine
Planning
- Count levels on a full sagittal localizer and label from a fixed landmark — never assume the first visible disc.
- Angle axial groups to each disc space individually; a single perpendicular block through a lordotic spine cuts obliquely at both ends.
- Keep the sagittal field of view wide enough to include the cord above and below the region of interest.
- Place saturation bands anteriorly to suppress swallowing, breathing and vascular motion.
- For dynamic studies, standardise flexion and extension positions so the two sets are genuinely comparable.
Sequences by study
| Study | Typical core | Why |
|---|---|---|
| Cervical spine | Sagittal T1 & T2, axial T2, optional STIR | Cord signal, disc levels, foraminal narrowing |
| Dorsal spine | Sagittal T1 & T2 with wide coverage, axial T2 at levels of interest | Long region — counting accuracy is the main risk |
| Lumbar spine | Sagittal T1 & T2, axial T2 angled per disc, STIR when trauma suspected | Disc, canal and marrow assessment |
| Dynamic study | Sagittal T2 in flexion and extension | Positional canal narrowing invisible in neutral |
| Plexus imaging | Coronal STIR, thin T2, post-contrast when indicated | Nerve signal against suppressed fat |
| MR myelography | Heavily T2-weighted thick-slab or thin-slice 3D | CSF-bright column without intrathecal contrast |
Mistakes that cost repeats
- Miscounted levels — the single costliest spine error; verify against a fixed landmark before filming.
- One axial block angled through a curved spine, producing oblique cuts at the extremes.
- Insufficient saturation, leaving vascular and swallowing ghosts across the cord.
- Cropping the sagittal field of view so the pathology sits at the edge of the image.
Common questions
- How do you avoid mislabelling spinal levels?
- Count on a wide sagittal localizer from a fixed landmark, document the counting reference, and re-verify before filming. Anatomical variants such as transitional vertebrae make assumption-based counting unreliable.
- Why angle axial slices per disc space instead of one block?
- The spine is curved. A single perpendicular block cuts obliquely through the discs at the top and bottom of the stack, distorting foraminal and canal appearances at exactly the levels being assessed.
- When is a dynamic flexion/extension study useful?
- When symptoms are positional. Canal narrowing and instability that disappear in the neutral supine position can become visible when the spine is imaged flexed and extended.
- What does STIR add to a spine protocol?
- Robust fat suppression that reveals marrow edema — key in trauma, infection and metastatic screening, where a T1/T2 pair alone can under-call bone involvement.
Try it in ScanFlo: Scan a lumbar axial group angled per disc space, then repeat as one straight block through the whole region. Compare the L5–S1 slices between the two — the shape distortion in the block version is what a radiologist would flag.