MRI Protocol for Evaluating Scoliosis of the Spine

Initial Assessment and MRI Protocol

• The American College of Radiology recommends radiography as the primary initial imaging modality for diagnosing and classifying scoliosis, evaluating severity, and monitoring progression 1, 3
• MRI is selectively used after radiography to detect and characterize suspected intraspinal abnormalities, with a focus on complete spine imaging without contrast, particularly in patients with congenital scoliosis or those with risk factors for neural axis anomalies 1, 2
• Physical examination should assess for risk factors requiring MRI, including left thoracic curve, short segment curve, absence of apical segment lordosis/kyphosis, rapid curve progression, functionally disruptive pain, focal neurological findings, and male sex 4, 5

MRI Protocol Components

• Complete spine imaging (cervical, thoracic, and lumbar) should be performed, including T1 and T2-weighted sequences in sagittal and axial planes to evaluate neural elements and potential abnormalities 2, 6
• No intravenous contrast is required for routine scoliosis evaluation, but gadolinium-based contrast agents should only be used when tumor or infection is suspected 1, 2, 7

Specific Patient Populations and MRI Indications

• The American College of Radiology strongly recommends MRI for all patients with congenital scoliosis, as neural axis anomalies occur in more than 20% of patients with congenital scoliosis 1, 6
• Selective MRI is recommended for idiopathic scoliosis based on risk factors, as 2-4% of adolescents with idiopathic scoliosis have intraspinal abnormalities detectable only by MRI 3, 4, 8
• Risk factors for neural axis abnormalities in idiopathic scoliosis include left thoracic curve, short segment curve, absence of apical segment lordosis, rapid curve progression, pain, neurological findings, male sex, and pes cavus 4, 5

Clinical Considerations and Pitfalls

• Absence of neurological symptoms does not rule out intraspinal abnormalities, and preoperative MRI is particularly important for surgical planning and to reduce potential complications 2, 6
• The clinical relevance of some intraspinal abnormalities remains unclear, even in presurgical settings 3

When to Consider Alternative Imaging

• CT may be preferred for presurgical planning and visualization of bony malformations, and low-dose CT protocols should be used when CT is necessary 1, 2, 6