Objectives: Standard MRI of the cervical spine is performed in a different anatomical position to that utilised for traditional contrast myelography. Those well practised in myelography are familiar with the considerable changes in configuration of the bony and soft tissues of the cervical spine that may occur with changes in the degree of neck flexion and extension. We set out to compare the findings in a select group of patients with myeloradiculopathy who had undergone myelography and MRI in both standard and neck-extended positions. These findings were correlated with the clinical status. Methods: 29 patients underwent myelography with CT (CTM) and MRI in neutral and neck-extended positions. The imaging was assessed for the degree of cord compression and neural foraminal narrowing, quantified using a simple grading scheme suitable for routine clinical practice. The degree of neck extension was assessed using an angular measurement. Results: For both CTM and MRI, scanning with the neck extended significantly increases the severity of cord compression compared with the standard supine position, to a degree similar to that shown during conventional prone myelography. The degree of perceived cord compression is related to the degree of neck extension achieved. Correlation of standard MRI findings and the clinical level of radiculopathy is poor. This correlation improves when the neck is extended. Conclusions: The most appropriate position for routine MRI of the cervical spine in degenerative disease remains unknown, but in selected patients imaging with the neck extended may provide important additional information. With the introduction of spinal surface coil technology and gradient echo sequences in the late 1980s, MRI rapidly replaced intrathecal contrast myelography as the standard imaging method for assessment of the cervical spinal cord and nerve roots. The two investigations are performed in very different anatomical positions. Standard cervical spine MRI is performed in a coil that is designed to make the patient comfortable, to minimise movement-related artefacts. This generally results in a position of mild extension of the neck. On the other hand, the majority of images for plain cervical myelography are obtained with the patient prone and the neck hyperextended so as to retain myelographic contrast within the cervical lordosis. CT myelography (CTM) is typically performed with the patient supine and with the neck straight or mildly flexed; however, CT myelography can also be performed in the prone position with the neck extended [1].For a number of years we continued to use plain myelography, with CTM as a second-line investigation in patients with cervical myelopathy and/or radiculopathy, when the results of standard MRI were inconsistent with symptoms and signs. More recently we have also performed MRI with neck extension, predominantly in patients with myelopathic features but inconclusive supine MRI. We have been unsure how extended MRI compares with myelography and whether it is able to produce t...

We report on three children from two families with Aicardi-Goutières syndrome. All three had congenital glaucoma. Additionally, neuroimaging demonstrated significant brain stem atrophy in the affected sib-pair. These features have not been previously described in Aicardi-Goutières syndrome and expand the phenotypic spectrum.

This is the first study to demonstrate added clinical value utilising extension MRI. In this cohort of difficult patients, when there was no T2 signal change in the cord, the presence of clinical myelopathy could only be predicted by utilising the data from extension imaging.

A prospective comparison was made of standard two-dimensional MRI sequences, at both high and midfield strength, with CT myelography in 23 patients with cervical spondylosis. MRI is adequate for assessment of cord compression, where high field strength is superior to midfield strength. MRI using 4-mm sections is inadequate for presurgical assessment of root compression. It remains to be proven whether thin-section white-CSF volume sequences or gadolinium-enhanced volume studies can replace CT myelography.

A prospective comparison was made of standard two-dimensional MRI sequences, at both high and midfield strength, with CT myelography in 23 patients with cervical spondylosis. MRI is adequate for assessment of cord compression, where high field strength is superior to midfield strength. MRI using 4-mm sections is inadequate for presurgical assessment of root compression. It remains to be proven whether thin-section white-CSF volume sequences or gadolinium-enhanced volume studies can replace CT myelography.