Question about cervical MRI images

[Jim M2]

Are cervical transverse views oriented the same as the lumbar - left side of image is right side of body?

I've got this new MRI imaging and there's no scout views. What's with that?

[mmglobal]

Jim,

Looking over MANY MRI's, I alway see that the axial images (view from top) are flipped and L side is R.

Sagittal images (views from side) are USUALLY scanned L to R, but I have seen some MRI's with the scan done R to L.

It really sucks when there is no scout image printed. IMH(I'm not a doctor)O, the lack of scout views is just laziness on the part of the person who printed them. The printing process lets them arrange the images for output. You might take the slides back to the imaging center and insist that they print a set with scout images.

Mark

[Jim M2]

Thanks Mark. I only have a CD, no films. I called the radiology lab. They said the scout images can be displayed if I play around with the CD software.

Here's portions of the radiologist's report. What little I understand seems to correlate with the various components of pain I experience. For all of you cervies, please comment if something jumps out at you.
______________
FINDINGS: Vertebral alignment is anatomic except for a grade one 2.5 mm retrolisthesis of C5 on 6. The spinal cord appears normal in caliber and signal. No Chiari malformation. Left sphenoid 8mm mucus inclusion cyst.

Occiput to C2: No significant ventral extradural defect.
...
C5-C6: Moderate disc space narrowing and desiccation. Anterior endplate osteophytosis and wide based protrusion. Right moderate and left mild uncovertebral osteophytosis with associated disc and retrolisthesis contribute to bilateral severe foraminal narrowing. The retrolisthesis and disc bulge abuts and slightly indents the ventral aspect of the cord.

C6-C7: Moderate disc space narrowing and desiccation. Anterior mild endplate osteophytosis. Mild circumferential bulge. Right moderate and left mild to moderate uncovertebral osteophytosis and associated disc contribute to right severe and left moderate foraminal narrowing. Mild facet degenerative change. Low T1 and high T2 signal assocated with the left greater than right C7 roots consistent with perineural cysts.

C7-T1: Normal disc height with desiccation. Right moderate and left severe facet degenerative change. Right mild and left moderate to severe foraminal narrowing from facet hypertrophic change. The left C7 and T1 facets adjacent to the joint show increased T2 and decreased T1 signal consistent with inflammatory, edematous or reactive marrow changes.
...

IMPRESSIONS:
1. C7-T1 right moderate and left severe facet degenerative change with right mild and left moderate to severe foraminal narrowing associated. The left C7 and T1 facets adjacent to the joint show inflammatory, edematous or reactive marrow changes. A facet joint fracture cannot be entirely excluded as MR is relatively insensitive to cortical bone. If the patient has pain localized to this region, consideration may be given to thin section CT to rule out fracture.
2. C6-C7 moderate disc degeneration, right greater than left uncovertebral osteophytosis and associated disc contributing to right severe and left moderate foraminal narrowing at the exiting C7 roots.
3. C5-C6 moderate disc degeneration with right greater than left uncovertebral osteophytosis and associated disc as well as retrolisthesis contributing to bilateral severe foraminal narrowing and slightly indenting the ventral aspect of the cord.
4. C4-C5 moderate disc degeneration with bilateral moderate uncovertebral osteophytosis and associated disc contributing to bilateral moderate to severe foraminal narrowing.
5. C3-C4 mild uncovertebral osteophytosis contributing to left greater than right mild forminal narrowing.
6. Multilevel facet DJD right C2-C3 mild to moderate, left C2-C3 mild, bilateral C3-C4 mild, bilateral C4-C5 mild, bilateral C6-C7 mild, right C7-T1 moderate, left C7-T1 severe, bilateral T1-T2 and T2-T3 mild.

[mmglobal]

Jim,

When I look at a report, I am often focusing on the adjectives as much as the pathologies listed. Your impressions yield

6 milds,
1 mile to moderate
7 moderates
2 moderate to severe, and
4 severes.

You have a lot of pathology listed. You sound something like me... more severe pathology with less symptoms than might be expected with such significant pathology.

This is the opposite of what I experienced with my lumbar problems... films don't look that bad, but I had disabling pain.

Unfortunately, the MRI is only part of the story. It sounds like there is a lot wrong there, but trying to discover what the relevant pain generators are and which ones are fixable will be a difficult (and possibly impossible) process.

Mark

[Jim M2]

Mark,
Thanks for the comments. I understand and agree. I think there's nothing that can be done at this point except to grin and bare it.

[Jim M2]

Now about these results

FINDINGS... C7-T1:... The left C7 and T1 facets adjacent to the joint show increased T2 and decreased T1 signal consistent with inflammatory, edematous or reactive marrow changes.

IMPRESSIONS:
1. C7-T1 ... The left C7 and T1 facets adjacent to the joint show inflammatory, edematous or reactive marrow changes. A facet joint fracture cannot be entirely excluded as MR is relatively insensitive to cortical bone. If the patient has pain localized to this region, consideration may be given to thin section CT to rule out fracture.

My observation
I do have lower cervical left side component of pain (C7-T1?). Among other things it keeps me from making certain motions especially when exercising. It's probably not my chief complaint (my chief complaint is chronic DDD pain and ever more frequent arm pain). Consider these scenarios.

I choose not to have a CT.
I have thin section CT, it doesn't show fracture.
I have thin section CT, it shows fracture.

What treatments, therapies, additional diagnostics etc could possibly apply?
What would you do?

Let me know if you have any experience or thoughts on this.

Many thanks,

[sahuaro]

Jim:
I'd be interested in answers to your questions, too.
May I suggest that you post this in a separate thread?

[Jim M2]

Sahuaro,
Good idea.