Abstract
Introduction
Cervical spine MRI with the neck in extension has been well described over the last 10 years, but its clinical value remains unknown.
Methods
We performed extension imaging in 60 patients in whom the initial neutral study showed borderline cord compression. Images were assessed using a previously validated grading system for cord compression. Multiple linear and area measurements were also obtained. Images were scored blindly and randomly. Inter- and intra-rater variability were determined in a subset of 20 cases. Independent clinical assessment utilised the Ranwat criteria.
Results
For most parameters inter/intra-observer variance of kappa/ICC > 0.6 was highly satisfactory. Standard MR was poor at discriminating between patients with and without myelopathy (ROC analysis, area under the curve (AUC), 0.52). This was considerably improved with extension imaging (AUC, 0.60), or by using the change in compression score between neutral and extension studies. Most measurements were not helpful; however, the ratio of cord area/CSF area at the level of maximum compression on extended images was the best discriminator (AUC, 0.71), as well as the presence of T2 change in cord substance (AUC, 0.68).
Conclusion
This is the first study to demonstrate added clinical value utilising extension MRI. In this cohort of difficult patients, when there was no T2 signal change in the cord, the presence of clinical myelopathy could only be predicted by utilising the data from extension imaging.
Similar content being viewed by others
References
Bartlett RJV, Rowland Hill CA, Rigby AS et al (2012) MRI of the cervical spine with neck extension: is it useful? BJ Radiol 85(1016):1044–52
Chen Chi-Jen, Hsu Hui-Ling, Niu Chi-Chien et al. (2003) Cervical Degenerative Disease at Flexion-Extension MR Imaging Radiology 227:136–142
Jinkins JR, Dworkin JS, Green CA et al (2003) Upright, weight-bearing, dynamic–kinetic MRI of the spine—review of the first clinical results. JHK Coll Radiol 6:55–74
Bostel T, Gerigk L, Hegewald A et al (2012) Dynamic magnetic resonance imaging of the cervical spine with high-resolution 3-dimensional T2-imaging. Clin Neuroradiol 22:93–99
Muhle C, Weinert D, Falliner et al (1998) Dynamic changes of the spinal canal in patients with cervical spondylosis at flexion and extension using MRI. Investig Radiol 33(8):444–449
Pfirrmann CWA, Dora C, Schmid MR et al (2004) MR Imafe-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology 230:583–588
Ogino H, Tada K, Okada K et al (1983) Canal diameter, anteroposterior compression ratio, and spondylotic myelopathy of the cervical spine. Spine 8:2024–9
Kanchiku T, Taguchi T, Kaneko K et al. (2001) A correlation between MRI and electrophysiological findings in cervical spondylotic myelopathy spine 26(13):E294-E299
Ranawat CS, O’Leary P, Pelluci P et al (1979) Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg (Am) 61:1003–10
Rigby AS (2000) Statistical methods in epidemiology. V. Towards an understanding of the kappa coefficient. Disabil Rehabil 22(8):339–344
McNeil BJ, Hanley JA (1984) Statistical approaches to the analysis of receiver operating characteristic curves in Medical Decision Making 4:137–150
Stafira JS, Jagadeesh RS, Yuh WTC et al (2003) Qualitative assessment of cervical spinal stenosis: observer variability on CT and MR images. AJNR 24:766–769
Braga-Baiak A, Shah A, Pietrobon R et al (2008) Intra- and inter-observer reliability of MRI examination of intervertebral disc abnormalities in patients with cervical myelopathy. EJR 65:91–98
Hulcelle P, Dooms G, Demeure R et al (1990) Cervical myelopathy: MRI evaluation of cord compression. J Belg Radiol 73:15–19
Kadanka Z, Kerkovsky M, Bednarik J et al (2007) Cross-sectional transverse area and hyperintensities on MRI in relation to the clinical picture in cervical spondylotic myelopathy. Spine 32(23):2573–2577
Takahashi M, Yamashita Y, Sakamoto Y et al (1989) Chronic cervical cord compression: clinical significance of increased signal intensity on MR Images. Radiology 173:219–224
Harrop JS, Naroji S, Maltenfort M et al (2010) A Clinical and Radiographic Evaluation and Correlation to Cervical Spondylotic Myelopathy. Spine 35(6):620–624
Morishita Y, Naito M, Hymanson H et al (2009) The relationship between the cervical spine canal diameter and the pathological changes in the cervical spine. Eur Spine J 18(6):877–883
Kara B, Celik A, Karadereler S et al (2011) The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI. Neuroradiology 53:609–616
Modic MT, Masaryk TJ, Mulopulos GP et al (1986) Cervical radiculopathy: prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography. Neuroradiology 161:753–759
Nardin RA, Patel MR, Gudas TF et al (1999) Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve 22(2):151–155
Kuijper B, Beelen A, van der Kallen BF et al (2011) Interobserver agreement on MRI evaluation of patients with cervical radiculopathy. Clin Radiol 66:25–29
Moazzaz P, Hong SW, Miyazaki M et al (2007) Positional MRI: a valuable tool in the assessment of cervical disc bulge. Spine 7(5):395, Suppl
Conflict of interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bartlett, R.J.V., Rigby, A.S., Joseph, J. et al. Extension MRI is clinically useful in cervical myelopathy. Neuroradiology 55, 1081–1088 (2013). https://doi.org/10.1007/s00234-013-1208-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-013-1208-z