Should the chin be tucked for a C-spine?

Only lowered slightly, so the neck lies straight in the coil. A hard chin tuck flattens the natural cervical lordosis, which can narrow the canal on the images and create a pseudostenosis.

Why angle the axial slices per disc instead of one block?

The cervical spine is curved. A single perpendicular block cuts the discs obliquely at the top and bottom, which volume-averages a normal disc into looking herniated. Angling a small stack to each disc keeps every level true.

Why must the per-disc stacks not overlap?

Where two stacks cross inside the canal, each excitation partly saturates the other stack's slices, so signal drops in a band across the image (cross-talk). Keep each stack short and centred on its own disc.

How do you stop swallowing from ruining a neck scan?

Place an anterior saturation band over the throat and instruct the patient to swallow only during the quiet gaps between sequences, never while the scanner is acquiring.

Cervical spine MRI protocol

High-stakes imaging of the spinal cord. You are answering whether a disc is pressing on the cord, whether it is demyelination, or a tumour. The lower neck is guarded by the shoulders and the swallow reflex.

By the ScanFlo Editorial Team · Updated 12 October 2026

In this section · Protocols

Protocols/Spine

Video language

When this study is used

Neck pain, arm pain (radiculopathy) or signs of cord compression (myelopathy).
Trauma, suspected ligament or cord injury.
Suspected demyelination or intramedullary lesion.

Patient & coil positioning

Head-first supine with the head and neck in the head–neck coil. Lower the chin slightly so the neck lies straight in the coil, but do not tuck it hard: a hard tuck flattens the lordosis and fakes stenosis.
Centre the laser on the middle of the neck, about 2.5 cm below the chin, then close the upper part of the coil.
Depress the shoulders ('reach your hands toward your feet') to clear artefact at the critical C6–T1 junction.
Ask the patient not to swallow during the scans; place an anterior saturation band over the throat and let them swallow in the quiet gaps between sequences.

Localizer

Three-plane localizer. The sagittal must show the pons and medulla down to T3. Miss T1 and the exam is incomplete.

Sequence planning

For each sequence below you get the reference line the slice group follows, how much it covers, and why the sequence is in the protocol at all. Plan against the localizer, not by eye.

Sagittal T2 TSE

Sagittal

Planning: On the coronal, parallel to the spinal cord, not the vertebral bodies (which may curve). On the axial, along the line from the centre of the vertebral body to the spinous process, so the slices fall on the midline. Cover from one transverse process to the other; the FoV runs from the pons to T3.

Why: The 'myelogram effect': bright CSF against the dark cord and discs makes compression obvious.

Sagittal T1 TSE

Sagittal

Planning: Copy the T2 sagittal's slices (Copy Parameter → Slices) so both stacks fall in the same place slice for slice.

Why: Anatomical reference and marrow assessment: fat and marrow bright, CSF dark.

Axial T2 TSE (one stack per disc)

Axial

Planning: A separate small stack for each disc space, each parallel to its own disc and perpendicular to the cord on the sagittal. Never use one straight block: it cuts a curved spine obliquely and fakes herniation. About 3 slices per level, centred on the disc, with no overlap in the canal.

Why: Disc, canal and foraminal assessment at each level.

Coronal STIR (T2 TIRM)

Coronal

Planning: On the sagittal, parallel to the cervical spine, following the curve of the neck; cover the vertebral bodies and the canal from front to back.

Why: Fat-suppressed fluid map: oedema in the marrow, ligaments and soft tissues, and lateral pathology such as the brachial plexus roots.

In the video

The video scans a ScanFlo Cervical Spine case. The angles are that patient's, so follow the landmarks, not the numbers.
Sagittal T2: 13 slices, 3 mm, 10% gap, FoV 240 mm, TR 3000 / TE 100 ms; tilted about 3° on the coronal. The T1 sagittal (TR 500 / TE 10 ms) copies it with Copy Parameter → Slices.
Axial T2: seven per-disc slice groups of 3 slices (21 slices, 3 mm, 50% gap), TR 4290 / TE 96 ms; each tilted 13–19° on the sagittal with the curve of the neck.
Coronal STIR: 17 slices, 3 mm, leaning about 10° forward on the sagittal.
The queue takes about 5½ minutes; the video shows the scan as a time-lapse.

Representative parameters

Treat these as ranges. Field strength, coil and vendor all move the numbers. What must not move is understanding why each sits where it does.

Sequence	Field	Matrix / FOV	Notes
T2 TSE sagittal	1.5–3 T	320 / 24–28 cm	Myelogram effect
T1 TSE sagittal	1.5–3 T	320 / 24–28 cm	Anatomy, marrow
T2 axial	1.5–3 T	256–320 / 16–19 cm	One stack per disc, 3 mm
STIR coronal	1.5–3 T	256 / 24–26 cm	Oedema, trauma, roots

Artifacts & how to fix them

Artifact	Typical cause	Mitigation
CSF pulsation	Pulsatile flow inside the canal	Flow compensation; raise TE; gate if needed
Shoulder / wrap artefact	Dense tissue and aliasing at C7–T1	Superior sat bands; swap phase to right–left
Swallowing ghost	Oesophageal motion millimetres from the cord	Anterior sat band; scan during quiet breaks
Metal blooming (fusion)	ACDF plate/screws on GRE	Switch to TSE, wide bandwidth, STIR not fat-sat

What am I looking at?

You are not reporting the study, but recognising pathology helps you keep it in the field of view and know when to add a sequence or contrast. How the common findings read on the console:

Finding	Sequence to check	How it reads
Myelopathy	Sagittal T2	Cord pinched to an hourglass with a bright focus inside; flag it
Disc herniation	Axial T2	Disc margin convex ('frowning') or asymmetric rather than concave
Demyelination	Sagittal T2	Bright focal spots within the cord substance
Marrow or ligament oedema	Coronal STIR	Bright against the suppressed fat; check the same level on the T1

Review checklist

Sagittal covers the craniocervical junction and the C7–T1 disc.
T1 sagittal copied from the T2, slice for slice.
Axial stacks angled per disc, each centred on its nucleus, none overlapping in the canal.
Cord–CSF contrast crisp; the cord reads grey with bright fluid both sides.
Shoulder and swallow artefact cleared from the lower levels.

Mistakes that cost repeats

A hard chin tuck flattening the lordosis into a pseudostenosis.
One straight axial block making a normal disc look herniated.
Overlapping per-disc stacks in the canal, so the slices saturate each other (cross-talk).
Missing T1 because the sagittal stopped short of the cervicothoracic junction.
Undepressed shoulders wiping out C6–T1.

Common questions

Should the chin be tucked for a C-spine?: Only lowered slightly, so the neck lies straight in the coil. A hard chin tuck flattens the natural cervical lordosis, which can narrow the canal on the images and create a pseudostenosis.
Why angle the axial slices per disc instead of one block?: The cervical spine is curved. A single perpendicular block cuts the discs obliquely at the top and bottom, which volume-averages a normal disc into looking herniated. Angling a small stack to each disc keeps every level true.
Why must the per-disc stacks not overlap?: Where two stacks cross inside the canal, each excitation partly saturates the other stack's slices, so signal drops in a band across the image (cross-talk). Keep each stack short and centred on its own disc.
How do you stop swallowing from ruining a neck scan?: Place an anterior saturation band over the throat and instruct the patient to swallow only during the quiet gaps between sequences, never while the scanner is acquiring.

Try it in ScanFlo: Plan the axial stacks two ways, angled to each disc and then as one straight block, and compare. The straight block bulges normal discs backward; the angled stacks show them true. That is the volume-averaging trap made visible. See ScanFlo MRI →

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