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Neuroradiology

Our Neuro section includes twelve board certified, fellowship trained radiologists. With over 25,000 annual interpretations of the spine, brain, head and neck, we have achieved significant subspecialty expertise.

To assist you in determining what imaging procedure is appropriate for your patient’s symptom or condition, we have listed below neuro imaging procedures for many typical indications. This is simply a quick reference guide. We are always available to consult on imaging procedures or to discuss an interpretation. Call us 24/7 at 866-927-RAD1 (7231).

Neuro Imaging Algorithm
By Symptom or Condition

Neuro Imaging AlgorithmNontraumatic back pain-Xrays followed by MRI of the Lumbar spine.

Nontraumatic neck or thoracic back pain-Xrays followed by MRI of cervical spine/thoracic spine.

Radiculopathy-MRI of appropriate spinal segment Vertebral Artery Dissection-MR angiogram preferred, though CTA may be provide adequate diagnosis.

Acute spine trauma-CT of cervical, thoracic, or lumbar spine as appropriate according to localized pain. This may be followed with MRI if symptoms persist as symptom may be related to bone contusion or disc herniation not evident by CT.

Ataxia/vertigo-MRI of brain with and without contrast, CT of head without contrast less optimal, if stroke suspected then may consider MRA of neck and Brain with the MRI. CTA can be substituted for MRA.

Neuro Imaging AlgorithmCerebrovascular disease-If chronic CTA or MRA of neck preferred to evaluate for atherosclerosis, alternatively Carotid duplex may be performed. If acute, MRI of brain without contrast. CT of brain less optimal.

Head trauma-CT of brain if acute, MRI brain without contrast if chronic.

Headache nontraumatic-MRI brain without contrast.

Primary tumor or metastatic disease-MRI with and without contrast of appropriate body part.

Seizure, movement disorders, focal neurologic deficit, sensorineural hearing loss, Pituitary/neuroendocrine pathology-MRI of brain with and without contrast.

Vision loss-MRI of brain without and without contrast. Also MRI of Orbit with and without contrast may be performed at same time if source of pathology suspected to be within orbit.

MRI relative contraindications-Cochlear implants, certain surgical prostheses (will be reviewed by MRI technologist), cardiac pacing devices, recent surgery.

Gadolinium contraindications-Contrast allergy, GFR value below 60, half dose of contrast given for GFR between 30-60, no gad given if GFR below 30.

Nonionic intravenous contrast relative contraindications-

  1. Contrast allergy (bronchospasm, SOB, Urticaria, Hives following injection). However, premedication with prednisone PO given (50mg at 13, 7, and 1 hour prior to study, and 50mg of Benadryl 1 hour prior to study).
  2. Creatinine levels below 1.5 require radiologist approval, creatinine levels between 1.5 and 2.0 low osmolar agent used (visapaque).

Neuro Imaging Algorithm
By Modality

MRI brain with contrast-Infection, metastasis, primary brain tumor, inflammatory process, multiple sclerosis, arteriovenous malformation (AVM), pituitary/endocrine abnormality.

MRI brain without contrast-Headache, mental status changes, stroke.

MRI angiogram of brain-Aneurysm, stroke, AVM.

MRI angiogram of neck-Stroke, carotid atherosclerosis, vertebral or carotid arterial dissection.

CT brain-Trauma, intracranial bleed, mental status changes, acute stroke.

CT brain with contrast-If MRI Brain with contrast is contraindicated.

CT angiogram of brain-Same indications as MRA of brain if MRI cannot be performed. Prior aneurysm surgery.

CT angiogram of neck-Same indications as MRA of brain if MRI cannot be performed. Prior aneurysm surgery.

MRI cervical spine-Disc herniation, foraminal or central canal stenosis, trauma (CT preferred if acute), radiculopathy, neck pain of unclear etiology.

MRI cervical spine with contrast-Tumor workup or metastasis, prior neck surgery, infection/osteomyelitis, Multiple Sclerosis.

MRI thoracic spine-Suspicion for disc herniation, trauma (CT preferred if acute), osteoporotic fracture.

MRI thoracic spine with contrast-Tumor workup or metastasis, prior spine surgery, infection/osteomyelitis, Multiple Sclerosis.

MRI lumbar spine-Disc herniation, foraminal or central canal stenosis, trauma (CT preferred if acute), radiculopathy, back pain of unclear etiology, osteoporotic fracture.

MRI lumbar spine with contrast-Tumor workup or metastasis, prior spine surgery, infection/osteomyelitis.

CT cervical spine-Acute or old fracture, if MRI contraindicated, prior back surgery if metal limits MRI evaluation.

CT thoracic spine-Acute or old fracture, if MRI contraindicated, prior back surgery if metal limits MRI evaluation.

CT lumbar spine-Acute or old fracture, if MRI contraindicated, prior back surgery if metal limits MRI evaluation.

Myelogram-Cervical, thoracic, or lumbar myelogram indicated if MRI is contraindicated, commonly used in postoperative patients with metallic implants that limits MRI evaluation. The exam used in conjuction with CT myelogram.

MRI brachial plexus-If brachial plexus injury suspected. MRI of cervical spine recommended first.

Nuclear medicine bone scan-Often useful to evaluate for metastatic bone disease, osteomyelitis, and for evaluation of indeterminate bone tumors seen by MRI, reflex sympathetic dystrophy.