Posted on Sep 08, 2020
It can detect a variety of conditions affecting the upper spine, as well as structural abnormalities like tumors, and problems in the soft tissues within the spinal column, including the spinal cord, nerves, and disks.
If you are experiencing pain or other symptoms in your neck or upper back, it is likely your doctor will ask you to get a cervical MRI. But imaging of the neck is complex, requiring specific expertise to be interpreted accurately. We spoke with Dr. Gaetano Pastena, a leading neuroradiologist and assistant professor at Albany Medical Center, to find out what patients should know before and after getting a cervical MRI.
DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging from one of our fellowship-trained subspecialty radiologists, you can learn more here.
[Dr. Pastena] Both MRI and CT are used to evaluate the neck and spinal cord. Each type of scan has unique strengths and limitations. A cervical CT uses x-rays to create a visual model of the upper spine. A cervical MRI, on the other hand, uses magnets and radiofrequency energy to produce detailed images of the upper spine.
While a cervical CT involves some radiation exposure, it is superior to a cervical MRI in regard to the speed of the exam. A cervical MRI is a longer exam but does not use radiation, eliminating any concerns of exposure. One of the major strengths of CT is its ability to visualize bone and calcium. MRI is better at visualizing and discriminating soft tissues, such as the spinal cord, muscles, ligaments, and discs. It is also the preferred modality to look for subtle bone marrow edema.
Cervical spine MRI is used to help diagnose conditions of the spinal cord itself, degeneration of the discs and vertebrae/backbones (which can lead to problems with the nerves and cord), and problems of the surrounding structures like muscles and ligaments.
[Dr. Pastena] A cervical MRI is a more complicated examination to read than a CT scan because it involves multiple different sequences that each have different properties and shows the tissues slightly differently. Each sequence of images must be interpreted both separately and then together, requiring a lot of time and expertise.
An MRI exam can also be more prone to artifacts (a feature that appears in an image but is not actually present - this can occur as a result of a patient’s movement during the exam, for example). These artifacts need to be caught and not mistaken for something else by the interpreting radiologist.
In my experience, a pitfall in interpreting a cervical MRI can be concentrating on the larger structures centrally, such as the spinal cord and center of the disc, and missing smaller or subtle peripheral findings - which may also cause pain or symptoms, such as arthritis in the joints of the spine or edema (swelling) of the muscles. Another pitfall may be in misinterpreting an abnormality of the spinal cord as one disease process when it may represent another, as several entities that affect the cord share a similar appearance with subtle differences.
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[Dr. Pastena] While any board-certified radiologist is eligible to read a cervical MRI, these types of exams are often complex and require the expertise of a subspecialist. Depending on a patient’s symptoms or condition, the best type of subspecialist for a cervical MRI is either a radiologist specializing in neuroradiology or a radiologist specializing in musculoskeletal radiology.
Subspecialty radiologists receive extra training for one or more years in their selected area of study and have additional expertise in looking at a particular type of exam. Their extensive experience allows them to develop a deep familiarity with the different appearances of disease and injury.
In a practice, a subspecialty radiologist often reads more studies that fall under their specific expertise than a general radiologist will because of their unique training. Usually, this means that the radiologist will develop a close working relationship with the surgeons and clinicians who are ordering the examinations. These types of relationships will, in turn, provide a beneficial feedback loop.
For example, a subspecialty radiologist will often have a greater depth of knowledge when it comes to:
Understanding these nuances helps catch rare or small abnormalities, ensures accuracy, and prevents misdiagnosis. If the interpreting radiologist lacks proper training, the risk for misdiagnosis increases.
[Dr. Pastena] A subspecialty second opinion is a great way to have your scans read by a specialist. If your study was not originally interpreted by a subspecialist, a second opinion can help by adding in that expertise. It can ensure that no subtle findings were missed during a busy day of reading and that two radiologists agree on the diagnosis. And even if your scans were initially read by a subspecialist, having a second pair of eyes looking carefully over your study to make sure nothing was missed and that findings were interpreted correctly can help ensure accuracy. If the second opinion diagnosis matches the first, it can provide peace of mind and confidence as you proceed to the next steps toward wellness.
While some practices have dedicated subspecialists to read their cervical MRI studies, others may not. This is something to keep in mind when you’re getting a cervical MRI. (Or any type of scan, for that matter.) With DocPanel, you submit your scans online and get your results back in 24-72 hours. It gives you the opportunity to access the same level of healthcare that you would at a prestigious medical institution, but at an affordable cost.
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[Dr. Pastena] Oftentimes, radiologists today are rushed to read a ton of scans. Some may also be assigned to read scans that do not fall under their expertise, or for which they have not had proper subspecialty training.
Getting a second opinion from an expert can provide peace of mind in knowing that your scan was read by the appropriate subspecialty trained radiologist. Knowing that the person interpreting your scan is taking the time to look it over well can offer a tremendous relief of anxiety. Successful treatment is dependent on an accurate diagnosis and second opinions can help ensure you get one.