Need some help with craniocervical imaging analysis!

[Scotty81]

Hello,

This post relates to those who've gotten upright MRI's of the brain and craniocervical spine, as a precursor to have the images be read by neurosurgeons such as Dr. Gilete, Bolognese, etc.

My daughter got the above images, and the script was specific in that it asked for an MRI of the craniocervical spine, with flexion, extension and rotational views. We then uploaded the disks to Dr. Gilete's website for his review & report.

Unfortunately, we just got an email back from their office saying that they did not see any axial cuts in rotation. Dr. Gilete's office asked that I contact the MRI facility to ask them:
1) Were axial cuts taken in rotation?
2) If not, could the MRI facility make axial cut imaging by reconstruction from the imaging made?

I contacted the MRI facility and they said they don't do such cuts. Ugh!
And, they said that they can't produce an axial cut image from the post processed data. Ugh!

They are looking into this to see what can be done, but I'm not hopeful they will know. My question is, has anyone else run into this problem? Does anyone know of any facility that can reconstruct the type of images that Dr. Gilete is looking for, assuming that the original MRI facility can't do it?

We took my daughter across country for an out of town appointment, and had the imaging done at a facility near that doctor's office. So, it's not feasible to go back and have any imaging redone.

@jeff_w - I'm over my head in terms of even knowing that we needed to find a facility that performed this specific type of imaging. At least, that's what Dr. Gilete's office needs. Do you have any advice at this point?

 

[Hip]

Don't know the answer to your question regarding getting imaging reconstructed, but these rotational views are only used to diagnose atlantoaxial instability (AAI). The imaging you do have should be enough to allow Dr G to detect CCI, Chiari and cervical spinal stenosis.

Rotational views can also be provided by CT scan machines, which are found in any hospital I believe. So that might be an option for you.

You might find this thread useful for general background reading about scans. Please do answer my CCI survey when you do get all your results in.

The survey found that it's rare to have AAI on its own. Nearly all patients with AAI also have CCI.

 

[toyfoof]

This exact same thing happened to me, and Dr. G just did his report without the information. As Hip says, the rotational views are only needed for the AAI diagnosis (C1-C2), and from what my report says, he can still get an idea. He said that AAI was likely in my case based on what he could see, and that the required views would need to be done to confirm the diagnosis.

I’m seeing a local neurosurgeon to discuss the report and I figure he’ll send me for the rotational CT scan if he’s concerned about confirming this diagnosis.

 

[Scotty81]

As Hip says, the rotational views are only needed for the AAI diagnosis (C1-C2)

@toyfoof - thanks for your input. It's funny you say what the rotational views are for. My daughter definitely rotated her head to the left and to the right, in addition to backwards and forwards. So, she had the views. It sounds like that Dr. G wanted the images sliced a certain way in their MRI machine; these were the axial cuts he was talking about.

So, in your case, did you not do the the rotational views at all, or did you do them but without the axial cuts? Can you also let me know what your local neurosurgeon says when you go?

Thanks.

 

[toyfoof]

Hi @Scotty81 — just like your daughter, I did do the rotational views. On the CD I received, I could see the images, the ones that look like you’re looking at the head/neck from the side, and you can see up and down the neck. I believe these are called sagittal views.

The views Dr G wants, axial, are the ones that are like you are looking straight down from the top, and you can see slices of the spinal cord surrounded by spinal fluid and the bone of the vertebra. These were on my CD for the neutral position, but not for the rotational. So there are some views in rotation, just not all of them that he uses for diagnosis.

I have a thread where I update my situation (I’m a little behind and haven’t updated since I received Dr G’s report, but I will) and I’ll post here when I meet with the neurosurgeon: https://forums.phoenixrising.me/threads/migraines-mris-and-mutts-my-me-cfs-experiences.62457/

I’ll try to remember to come back to this thread and update, too. The appointment is November 11. Feel free to tag me if you think of it.

 

[Hip]

It sounds like that Dr. G wanted the images sliced a certain way in their MRI machine; these were the axial cuts he was talking about.

There are 3 ways you can cut a body scan image: sagittal, coronal and axial:

Sounds like you had the right rotational images taken (head looking left and right), but these images were not cut in the right way.

 

[Daffodil]

you guys should all be a part of the facebook group!

 

[Bowser]

Recently Dr. G suggested to me to get CT scan instead of a supine MRI for rotational view.

The supine MRI does not get quality images in rotation.
We suggest a CT Scan in rotation to the left and right with true axial views of C1-C2.

I'm not sure what a "true" axial view means though. What does "true" mean here?

 

[Scotty81]

@Daffodil - Can you let me know what Facebook group you are referring to? I know there is one that was discussed in the main thread on CCI, but I'm not sure if there is another one.

@Bowser - I got the same reply from Dr. G's office, and so I called a local CT scanning facility and read them that exact sentence. They said that they do what Dr. G. wants and that they actually take the images in the axial view. They will also reconstruct the images in the other 2 planes (sagittal and coronal) as @Hip noted above.
So, I'm not sure what "true" refers to, but I'm guessing that it is the view that the CT image is taken and not some reconstructed image afterwards. However, I didn't ask them.

All - I'm hoping that the CT scan can be performed without contrast. Does anyone know? My daughter had severe GI side effects from the last time she was administered CT contrast, so I hope it can be done without it.

 

[Daffodil]

@Daffodil - Can you let me know what Facebook group you are referring to? I know there is one that was discussed in the main thread on CCI, but I'm not sure if there is another one.

@Bowser - I got the same reply from Dr. G's office, and so I called a local CT scanning facility and read them that exact sentence. They said that they do what Dr. G. wants and that they actually take the images in the axial view. They will also reconstruct the images in the other 2 planes (sagittal and coronal) as @Hip noted above.
So, I'm not sure what "true" refers to, but I'm guessing that it is the view that the CT image is taken and not some reconstructed image afterwards. However, I didn't ask them.

All - I'm hoping that the CT scan can be performed without contrast. Does anyone know? My daughter had severe GI side effects from the last time she was administered CT contrast, so I hope it can be done without it.

these 2 might be good groups for you:


ME/CFS+ (Mechanical and Structural Approaches, Alpha Group)

Craniocervical Instability

 

[Bowser]

@Daffodil - Can you let me know what Facebook group you are referring to? I know there is one that was discussed in the main thread on CCI, but I'm not sure if there is another one.

@Bowser - I got the same reply from Dr. G's office, and so I called a local CT scanning facility and read them that exact sentence. They said that they do what Dr. G. wants and that they actually take the images in the axial view. They will also reconstruct the images in the other 2 planes (sagittal and coronal) as @Hip noted above.
So, I'm not sure what "true" refers to, but I'm guessing that it is the view that the CT image is taken and not some reconstructed image afterwards. However, I didn't ask them.

All - I'm hoping that the CT scan can be performed without contrast. Does anyone know? My daughter had severe GI side effects from the last time she was administered CT contrast, so I hope it can be done without it.

I just had a CT scan done today for rotational view. Also had an MRI for neutral, flexion and extension. For both scans contrast was not used.