MRI Lumbar Spine

Protocol sequences

Introduction

MRI Lumbar spine is one of the common scans in MRI. Scan is mainly requested for patients who suffer from backaches due to intervertebral disk bulging. Five to six sequences are performed routinely, but protocol may occasionally change due to pathologies including metastasis, fractures and scoliosis.

Patient preparation

• Ask the patient to remove metallic items such as jewellery and remove any clothing that contains ferromagnetic materials.
• Obtain MR safety consent after evaluating possible MR contraindications and take the necessary action if required.
• Explain that gradient noise and couch movements are normal.
• Demonstrate how to use the nurse call system and explain when to use it.
• Explain the importance of remaining still during the scan.
• Help claustrophobic patients overcome their fear through demonstrations, or allow a companion to stay with the patient during the scan.
• Inform the patient of the expected duration of the scan.

Patient positioning

• Posterior coil, which is in the scanner couch, is used for the scan.
• Position the patient head first and supine.
• Make sure that the patient lies centrally and symmetrically in the MR couch.
• Provide a cushion under the knees for extra comfort and reassure the patient.
• Position the patient’s limbs without forming body loops.

Explanation: Body loops may generate eddy currents, which can cause RF burns on the skin. Insulating soft pads may be used to break conductive loops that may form between the feet and thighs or between the trunk and the arm.

• Provide ear plugs to reduce scanner noise.
• Center the scan on the Iliac crest.

Sequences in detail

I. Myelogram_Coronal_Spine

Planning

• Scan coverage: Include the entire spinal canal of the lumbar spine.
• Plan block angulation: Align to the spinal canal.

Parameters

Purpose

• To view the spinal canal for planning and anatomical evaluation.

II. T2_Sagittal_Spine

Planning

• Scan coverage: Include the entire lumbar spine, entire neural foramina and immediate paraspinal soft tissue. FOV should cover from T12 to S1.
• Plan block angulation: Align the sagittal slices parallel to the spinal canal in the coronal myelogram.
• Technical applications: Place a saturation band to cover the abdominal wall and bowel. This minimizes motion artifacts due to bowel and abdominal wall movements.

Parameters

Purpose

• Anatomical evaluation.

III. T1_Sagittal_Spine

Planning

• Scan coverage: Include the entire lumbar spine, entire neural foramina and immediate paraspinal soft tissue. FOV should cover from T12 to S1.
• Plan block angulation: Align the sagittal slices parallel to the spinal canal in the coronal myelogram.
• Technical applications: Place a saturation band to cover the abdominal wall and bowel. This minimizes motion artifacts due to bowel and abdominal wall movements.

Parameters

Purpose

• Evaluate spinal bone marrow.

IV. STIR_Sagittal_Spine

Planning

• Scan coverage: Should include the entire lumbar spine, entire neural foramina and immediate paraspinal soft tissue. FOV should cover from T12 to S1. 
• Plan block angulation: Align the sagittal slices parallel to the spinal canal in the coronal myelogram.
• Technical applications: Place a saturation band to cover the abdominal wall and bowel. This minimizes motion artifacts due to bowel and abdominal wall movements.

Parameters

Purpose

• Differentiate focal lesions.

V. T2_Axial_Disk

Planning

• Scan coverage: Include the spinal canal and the neural foramina.
• Plan block angulation: Align axial slices perpendicular to the spinal canal in the coronal myelogram, and parallel to the intervertebral disks in the sagittal T2 image.
• Technical applications: Place a saturation band to cover the abdominal wall and bowel. This minimizes motion artifacts due to bowel and abdominal wall movements.

Parameters

Purpose

• Anatomical evaluation and diagnosis of disk bulging.

VI. T1_Axial_Disk

Planning

• Scan coverage: Include the spinal canal and the neural foramina.
• Plan block angulation: Align axial slices perpendicular to the spinal canal in the coronal myelogram, and parallel to the intervertebral disks in the sagittal T2 image.
• Technical applications: Place a saturation band to cover the abdominal wall and bowel. This minimizes motion artifacts due to bowel and abdominal wall movements.

Parameters

Purpose

• Anatomical evaluation.

Reference

1. Douglas N. Mintz, MD, FACR, Chair, Saad Ali, MD, Avneesh Chhabra, MD, and Thomas Lee, MD. 2023. ACR–ASNR–SABI–SSR Practice parameter for the performance of magnetic resonance imaging (MRI) of the adult spine.
2. Sollmann N, Fields AJ, O'Neill C, Nardo L, Majumdar S, Chin CT, Tosun D, Han M, Vu AT, Ozhinsky E, Shah LM, Harris RE, Lobo R, Anderst W, Herzog R, Psioda MA,Standaert CJ, Price RT, Lotz JC, Link TM, Krug R. Magnetic Resonance Imaging of the Lumbar Spine: Recommendations for Acquisition and Image Evaluation from the BACPAC Spine Imaging Working Group. Pain Med. 2023 Aug 4;24(Suppl 1):S81-S94. doi: 10.1093/pm/pnac130. PMID: 36069660; PMCID: PMC10403314.
3. Zerunian M, Pucciarelli F, Caruso D, De Santis D, Polici M, Masci B, Nacci I, Del Gaudio A, Argento G, Redler A, Laghi A.Fast high-quality MRI protocol of the lumbar spine with deep learning-based algorithm: an image quality and scanning time comparison with standard protocol. Skeletal Radiol. 2024 Jan;53(1):151-159. doi: 10.1007/s00256-023-04390-9. Epub 2023 Jun 28. PMID: 37369725; PMCID: PMC10661795.
4. Sayah A, Jay AK, Toaff JS, Makariou EV, Berkowitz F. Effectiveness of a Rapid Lumbar Spine MRI Protocol Using 3D T2-Weighted SPACE Imaging Versus a Standard Protocol for Evaluation of Degenerative Changes of the Lumbar Spine. AJR Am J Roentgenol. 2016 Sep;207(3):614-20. doi: 10.2214/AJR.15.15764. Epub 2016 Jun 8. PMID: 27275868.