Article Review 12

Authors’ names

Scott R. Laker, M.D,. Leah G. Concannon, M.D.

Article name

Radiologic Evaluation of the Neck: A Review of Radiography, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging, and Other Imaging Modalities for Neck Pain

Journal Name

Radiology evaluation of the neck, Phys Med Rehabil Clin N Am 22 (2011)

Bibliography

Laker, S. R., & Concannon, L. G. (2011). Radiologic Evaluation of the Neck: A Review of Radiography, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging, and Other Imaging Modalities for Neck Pain. Physical Medicine and Rehabilitation Clinics of North America, 22(3), 411–428. doi:10.1016/j.pmr.2011.03.010

Purpose of the article

The purpose of this article was to reviews the current literature on imaging for the patient with neck pain, illustrates several imaging abnormalities, and discusses the workup of commonly seen patient populations.

Brief Description of Procedure and Findings/Results

This article is using descriptive study which systematically reviews some articles regarding radiology modalities used to diagnose neck pathology. There are many pathologies of neck including Chiari Malformation, Cervical Myelopathy, Ankylosing Spondylitis, Os Odontoideum, Klippel-Feil Anomaly, and rheumatoid arthritis. Radiology modalities such as nuclear medicine, ultrasound, computed tomography, magnetic resonance imaging, and conventional radiography facilitate the diagnosis in a different way result in information from the image generated.

Radionuclide studies reflect the function of tissue because it interacts with the specific isotope. The emitted radiation is acquired by a gamma camera and converted into images by the computer’s software.

Plain radiography of the cervical spine has certain advantages over more advanced imaging techniques. Imaging is inexpensive, quick, and easy to perform, and exposes the patient to significantly less radiation than computed tomographic (CT) scans. However, radiographs are insensitive to many disorders of the cervical spine, and these disorders may require adjuvant advanced imaging confirmation.

MRI allows for evaluation of bony detail, marrow signal, malalignment, stenosis, and radiculopathy using 1 test without ionizing radiation. As such, MRI is replacing CT as the first-line advanced imaging for the patient with neck pain. It provides excellent contrast between the spinal cord, intervertebral disks, vertebral bodies, and ligamentous structures and assesses multiple additional aspects of soft tissue or osseous abnormalities.

CT is excellent for complex osseous abnormalities, instrumented patients, and surgical planning. With advancing technology, submillimeter cuts can be obtained rapidly and compiled to create 3-dimensional re-creations. In addition, CT is the imaging modality of choice in obtunded trauma patients when clearing the cervical spine.

Ultrasonographic imaging has been gaining popularity in musculoskeletal medicine as a diagnostic tool and for image-guided procedures. Its utility as a diagnostic tool is severely limited in the cervical spine, given its inability to image through the bone into the central canal or intervertebral foramen.

This article reviewed the advantages and disadvantages of each modality. Studies have found conflicting results using cord signal as a prognostic factor for postsurgical improvement. Hypointensity on T1-weighted image is much less common and is associated with poorer surgical outcomes. Asymptomatic CSM on MRI is not an indication for surgery, although it may warrant specialty consultation.

Conclusions and Comments

There are various pathologies of neck and modalities to facilitate diagnosis. T2-weighted images are commonly seen in cervical myelopathy but have not been shown to be a prognostic factor. Imaging the patient with neck pain requires an in-depth understanding of anatomy, abnormality, and the modality being used to perform the investigation. Information gathered from the history and physical examination directly affects the study ordered by the physician

The opinion of the article

I found this article is very related to my course which is comparative imaging. This article managed to give a view of different information generated from different modalities and it has its own pros and cons. Apart from that, the important point of this article is radiographers and physicians should review the patient history together with the indication before proceeding to radiology examination. The indication is most important to define the best modality.