What conditions will a spinal mri diagnose or rule out for pinched nerves

[Wesley_Clark]

I had a Dr recommend an mri to see if there are any spinal issues. What conditions will an mri diagnose or rule out?

Stenosis, slipped discs, degenerative disc disorder? What else could be seen in an mri that could cause nerve compression?

Also is mri the best method to examine a spine for abnormalities? I heard CT isn’t as good for soft tissue but I know nothing about it. What does it mean with or without contrast? Is that for other body parts?

What is CT better for than mri?

[Qadgop_the_Mercotan]

Well, all that is about a 4 hour lecture in med school.

From a recent lecture:

In general, MRI is the procedure of choice for all neurologic and orthopedic diagnoses, while CT is the preferred modality for examining the chest, abdomen, pelvis, and skull base.

MRI
•All Brain applications
•Even acute parenchymal or subarachnoid hemorrhage
•Advantage of adding intracranial angiogram for applications such as SAH, diplopia, vasculopathy
•All Spinal Cord, Spine, and Vertebral applications
•For older patients CT may be substituted, as degenerative change is more of a factor than disc protrusion
•All Orbit, Sensoryneural Hearing Loss, Pituitary, and Cranial Nerve applications
•All Joints
•From fingers to toes
•Includes soft tissue tumors and injury
MRI and CT Complimentary
•Cervical Soft Tissues
•MRI (frequently with contrast) generally preferred for cancer staging
•CT preferred for examining larynx (glottis), stones, mandible/maxilla invasion, thyroid
•Liver, Pancreas, Kidney examinations
•MRI can assist with problem solving for CT images, particularly where the use of contrast is contraindicated as in renal function concerns or significant contrast reaction history
•The use of Gadolinium bolus in MRI examination of liver and kidneys is equivalent to CT with contrast, and adds another parameter to the exam
•The application of Teslascan contrast also enhances MRI of the liver, pancreas, and cholangiogram to compliment CT exams
•Gynecologic applications
CT
•Skull Base, Sinuses, Tympanomastoid applications
•Preferred for diagnosis of sinusitis, otitis, conductive hearing loss, erosion
•Chest exams
•Preferred modality for cancer, pneumonia, and abnormal chest x-ray
•High resolution 1-2 mm sections used for examining interstitial lung disease and solitary pulmonary nodules
•MRI can be used for the mediastinum if CT contrast is contraindicated
•Abdomen and Pelvis applications
•Used for cancer staging, abdominal mass or pain, kidneys and collective systems, gall bladder

more later, if I have time.

[Qadgop_the_Mercotan]

Also note that MRI is great for identifying stuff on the spine and elsewhere whose clinical significance is completely unknown. Tons of folks with no back problems of significance have horrible looking spines, bulging discs, ugly stenosis, etc. when seen on MRI. Which is why we should treat the patient, not the imaging study.

And tons of folks with back problems who had disc surgery did not get better after their disc surgery because the bulging disc seen on MRI was not the cause of the symptoms, either.

[Wesley_Clark]

I’ve heard that is a problem with other body parts, just because something looks abnormal on a scan that doesn’t mean that is the problem. Lots of people with a torn meniscus feel no symptoms, some people with a healthy one have knee pain and some have both knee pain and a tear. That complicates things.

[aruvqan]

@Qadgop_the_Mercotan

And tons of folks with back problems who had disc surgery did not get better after their disc surgery because the bulging disc seen on MRI was not the cause of the symptoms, either.

I have always wondered about those laser back surgery commercials … I have lumbar spinal stenosis covering multiple vertebra and I can not imagine it being effective with only a 1 inch incision … I will go along with being up and walking within one day - I did pretty extensive rehab and understand why one needs to get up and power through pain.

[gotpasswords]

[QUOTE=Wesley Clark]
Stenosis, slipped discs, degenerative disc disorder? What else could be seen in an mri that could cause nerve compression?
[/QUOTE]

A few other issues that I can think off offhand… bone spurs, broken vertebrae, various tumors and similar unwanted growths.

If you’re able to get an upright MRI with flexion/extension scan runs, you can also see positional instability.

Spinal CT scans are better at visualizing bones, so they’re generally not used for diagnostic reasons, but they are quite useful for evaluating post-op healing of fusions or implants as they’re less badly perturbed by metal in the area. This page has a series of different imaging technologies of the same area. The MRI is hopelessly blotted out by a huge black hole and crazy warping. The CT has some strong streaking, but the bones are at least in their actual shapes.