MRI is the imaging modality of choice for imaging the spine in a child with a neurological deficit. The multiplanar capability of MRI allows the visualization of the spine in 3 planes, and the contrast resolution allows excellent conspicuity of the intraspinal contents, vertebral bodies, and discs and paraspinal soft tissues. This is illustrated in the following example of a 10-year-old child who presented with a mass in the posterior triangle of the neck.
Recommendations for spine MRI scanning in children:
- Routine study includes T1- and T2-weighted images: Conventional MRI of the spine includes sagittal T1- and T2-weighted images and axial T1- and T2-weighted images through any abnormality.
- Scan entire spine when dysraphism is present: For imaging of congenital anomalies, e.g., spinal dysraphism, spaced axial T1-weighted images are acquired along the length of the spine to ensure detailed visualization of the cord and filum terminale. Sagittal image thickness should be reduced to 3 mm to allow for the small size of the pediatric spine (6).
- Fat-saturated MRI for trauma: The addition of fat-saturated T1- and T2-weighted (or STIR images) in the sagittal and axial planes is helpful in trauma cases, as these imaging techniques are very sensitive to bone marrow edema and ligamentous injury.
- Include brain images if infection is suspected: Imaging of the brain in children with spine disease or trauma may aid the diagnostic process. Involvement of the brain and spine would guide the radiologist towards the diagnosis of acute disseminated encephalomyelitis or infection.
- Leptomeningeal involvement by tumor: Disseminated tumors also involve the leptomeninges of the brain and spine (figure below).
- MRI usually requires sedation or general anesthetic in the young child.