Could dynamic MRI imaging help identify more people with Cervical Myelopathy

[Iwan]

J.Tempest-Mitchell

A group from Beijing have been looking at the medical literature as to whether a modified form of MRI called ‘dynamic supine’ MRI [dsMRI] might help to diagnose a greater number patients suffering from CSM (1). And their findings suggest it might!

​dsMRI is a modified form of the normal imaging technique, first introduced in the 1980s. This form of dynamic MRI imaging can be carried out in the same, standard, MRI machines we use now. Images are still taken with the patient lying down in the scanner (‘supine’), but rather than just take one series of images, the spine is imaged through a range of different neck positions (‘dynamic’), so its effect on the spinal cord can be seen. The major drawer back for patients is the imaging takes even longer (the researchers in this article estimate this would be an additional 15 minutes) and holding the different neck positions may not be possible for patients, as it could exacerbate their symptoms.

Do you suffer from CSM or know someone who does? Then share your experiences to help researchers understand the disease

​In this article, the researchers found thirteen previous studies comparing dsMRI to traditional MRI techniques in the diagnosis of CSM. They found that on average, dsMRI was able to identify compression that was either missed or underestimated by traditional techniques in around 20% of patients. This suggests that dsMRI may be able to measure spinal cord compression with a higher degree of sensitivity.

It should be noted that the types of studies conducted so far are at risk of bias which means that the conclusions of this study can only be hesitant. Nevertheless, these findings are interesting as they have identified clear examples of where a standard MRI may not identify any compression, yet dsMRI does. And of course, many doctors rely on ‘MRI compression’ to make their diagnosis.

Additionally given ‘basic’ MRI imaging has been shown to poorly predict the severity of CSM and therefore response to surgery, could dsMRI change this and better inform patients?

One thing is certain, more investigation is required!

References

(1) Nanfung Xu et al. Does Dynamic Supine Magnetic Resonance Imaging Improve the Diagnostic Accuracy of Cervical Spondylotic Myelopathy? A Review of the Current Evidence, World Neurosurgery dx.doi.org/10.1016/j.wneu.2....

Cervical Myelopathy

[Agenesis1]

Speaking for myself I have been asking doctors how can a MRI laying down in one position show the real impact of daily standing walking, reaching and movement of the neck and spinal cord compression. When I go for my Cancer Scans ( I had Sarcoma in my left thigh) and I am in there an hour and a 21 minutes and 22 seconds, for Thigh and Chest with and without contrast, I have to have them raise my head or I choke on my own spit..and my neck spasm will cause movement in my extremities, which will stop the MRI and add more time. HOWEVER, when my head is at a 20% angle, the rest of my body goes numb after awhile and the pain I end up laying there very still with tears running down my face and when they finally are done and undo my ankles the jerking and pain of legs The only thing that saves me from screaming outloud and moving is the music they play and just thinking of all the sleepless nights I experience with the same pain and knowing my brain cannot take it anymore, and for now this is the worst it can be at the moment.

[Iwan Administrator]

Sorry to hear about your symptoms, I agree with you and the article MRI's should have dynamic imaging to see the true extent of the compression,my symptoms heightened when I used to hyper extended my neck up or down My range of motion is now limited in that direction because of my ACDF at C4/C7

[Agenesis1 in reply to Iwan]

It could be the Ordering of the CT's, MRI's the simple ones and most used are automatically ordered "The Tunnel Vision Effect" The same test should not be ordered for everyone. Being labeled as a patient is far too common.. Plain views and 2D and 3D CT and "Multiple" views are just or very important for the cervical spine top to T2, in the diagnosis process. A picture is worth a 1000 words it could also have a 1000 different diagnosis. I too am sorry for your pain..I haven't had surgery, but just to let you know I really don't have range of motion because if I move my head while standing up I lose my balance, end up in a wall, door or almost fall over, so I exercise my neck while sitting or shrugging my shoulders. Kinda in the same boat by not really. Wanted to add that I did not have chemo or any drugs that would impact my Myelopathy, since my doctor took out the lump in his office then sent it for biopsy, and came back Cancer DX. Left town to the big city and the Sarcoma Specialist did a radical 8 inch resection which was too large for Chemo and the oncologist "noticed" my limitation, bone, muscle pain and voted against it. It did wreck my routine of pain management, and all with limping around for a few months.

I would like to add, although the rare outcome of paralysis with Cervical surgery there should be a standard assessment of the 12 pairs of nerves and the Ligaments at the base of the skull to rule out any hidden causes as well. This new MRI technique would most likely do it all at once vs separate tests,

Thank you Iwan

[Iwan Administrator in reply to Agenesis1]

Your more than welcome the dizziness sucks I still get it once in a while when my neck muscle decide to clamp down around my Cervical spine like you I keep trying to do my exercises ,all the very best with everything and I'm sure I will post some new blogs when they arrive on the website