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Evaluation of magnetic resonance myelography in the investigation of cervical spondylotic radiculopathy

Department of Neuroradiology, Regional Neurosciences Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK

View larger version (73K): [in a new window]   Figure 1. (a) Normal anteroposterior and (b) 45° left anterior oblique MR myelogram demonstrating cervical nerve rootlets extending from the cord surface into the exit foramina.

View larger version (77K): [in a new window]   Figure 2. (a) Left anterior oblique MR myelogram in a patient with left cervicobrachalgia shows abnormal tissue relating to the left C6/7 exit foramen, with compression of the exiting left C7 nerve root (arrow). Multilevel transverse indentations on the cerebrospinal fluid (CSF) column correspond to the presence of disc complexes indenting the ventral CSF space. (b) Axial T2 image at C6/7 confirms the presence of left-sided osteophytic foraminal narrowing and compression of the left C7 nerve root.

View larger version (87K): [in a new window]   Figure 3. (a) 45° right anterior oblique MR myelogram in a patient with right cervicobrachalgia showing prominent compression of the exiting right C6 nerve root (large arrow). There is a smaller indentation on the exiting right C5 nerve root (small arrow). (b) Axial T2 image at C5/6 confirms the presence of right-sided osteophytic foraminal stenosis. (c) Axial T2 image at C4/5 demonstrates a smaller broad-based disc complex which is mildly impinging on the exiting C5 nerve roots. This finding was overlooked on review of conventional imaging alone and was detected because of the MR myelographic appearances.

View larger version (117K): [in a new window]   Figure 4. (a) Axial T2 image at C5/6 in a patient with left-sided brachalgia shows bilateral exit foraminal stensosis and C6 nerve root compression. Similar disease was present at C6/7. (b) Axial T2 image at C4/5 showing possible narrowing of the left and right exit foramina. This was interpreted as bilateral foraminal stenosis on review of conventional MRI alone. (c) MR myelogram confirms compression of the exiting left and right C6 and C7 nerve roots. The exiting C5 nerve roots however are clearly seen and are not compressed (arrows).