Normal morphology, age-related changes and abnormal findings of the cervical spine. Part II: magnetic resonance imaging of over 1,200 asymptomatic subjects

Abstract

Purpose The aim of this study is to establish standard MRI values for the cervical spinal canal, dural tube, and spinal cord, to evaluate age-related changes in healthy subjects, and to assess the prevalence of abnormal findings in asymptomatic subjects. Methods The sagittal diameter of the spinal canal and the sagittal diameter and cross-sectional area of the dural tube and spinal cord were measured on MRIs of 1,211 healthy volunteers. These included at least 100 men and 100 women in each decade of life between the third (20s) and eighth (70s). Abnormal findings such as spinal cord compression and signal changes in the spinal cord were recorded. Results The sagittal diameter of the spinal canal was 11.2 ± 1.4 mm [mean ± standard deviation (SD)]/11.1 ± 1.4 mm (male/female) at the mid-C5 vertebral level, and 9.5 ± 1.8/9.6 ± 1.6 mm at the C5/6 disc level. The crosssectional area of the spinal cord was 78.1 ± 9.4/ 74.4 ± 9.4 mm 2 at the mid-C5 level and 70.6 ± 11.7/ 68.9 ± 11.3 mm 2 at the C5/6 disc level. Both the sagittal diameter and the axial area of the dural tube and spinal cord tended to decrease with increasing age. This tendency was more marked at the level of the intervertebral discs than at the level of the vertebral bodies, especially at the C5/6 intervertebral disc level. The spinal cord occupation rate in the dural tube at the C5 vertebral body level averaged 58.3 ± 7.0%. Spinal cord compression was observed in 64 cases (5.3%) and a T2 high-signal change was observed in 28 cases (2.3%). Conclusions Using MRI data of 1,211 asymptomatic subjects, the standard values for the cervical spinal canal, dural tube, and spinal cord for healthy members of each sex and each decade of life and the age-related changes in these parameters were established. The relatively high prevalence of abnormal MRI findings of the cervical spine in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely correlating these findings with clinical signs and symptoms.

Clinically Feasible Microstructural MRI to Quantify Cervical Spinal Cord Tissue Injury Using DTI, MT, and T2*-Weighted Imaging: Assessment of Normative Data and Reliability

“…CSA increased between the C3 and C6 vertebral levels, reflecting the cervical enlargement that contains increased GM for C5-T1 neurologic levels, and our CSA measurements were highly similar to those in previous reports. 32,33 WM FA peaked at C2 and locally at C7, where the orientations of axons are almost purely rostrocaudal. In contrast, decreases were seen at C1 (likely due to decussation of corticospinal fibers) and in the cervical enlargement (where a fraction of axons turn and form synapses within the GM).…”

Dimensional changes of cervical and lumbar bony spinal canals in one generation in Western Switzerland: a computed tomography study

“…All measurements were performed using the multiplanar reconstruction viewing mode, in a plane perpendicular to the longitudinal axis of the spine and at pedicle levels ( Fig. 1), given that degenerative changes influence spinal canal dimensions at disc levels [9,[14][15][16]. The window level and width of CT images were set to 350 and 2000 Hounsfield units, respectively.…”

A Novel MRI Biomarker of Spinal Cord White Matter Injury: T2*-Weighted White Matter to Gray Matter Signal Intensity Ratio

“…3 The strongest results include cross-sectional area (CSA) as a measure of spinal cord atrophy, the DTI metric fractional anisotropy (FA) to evaluate axonal integrity, and the magnetization transfer ratio (MTR) as a measure of demyelination. 3 Spinal cord CSA has shown moderate-to-strong correlation with disability in MS [4][5][6] but is a nonspecific measure of tissue injury and shows high intersubject variability in healthy subjects, 7,8 somewhat limiting its utility. FA has demonstrated moderate correlation with global and focal disability in dozens of studies involving various pathologies 3,[9][10][11][12][13][14] but has yet to achieve clinical uptake due to a lack of standardized/portable acquisition methods and cumbersome analysis techniques.…”