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MRI Total Spine (Cervical/Thoracic/Lumbar) With and Without Contrast

MR+ ContrastSpine

Indications

Metastatic disease survey / cord compression
Multiple myeloma
Suspected drop metastases / leptomeningeal disease
Multifocal demyelination (NMO/MS)
Infection survey
Polytrauma

Patient prep

MRI safety screening
IV access for contrast
Spine array coil; may require coil repositioning/large coverage

Contrast

Agentgadolinium-based

RouteIV

Dose0.1 mmol/kg

TimingPost-contrast T1 of all three regions when indicated (tumor/infection/leptomeningeal)

Technique

Sagittal survey of entire spine in 2-3 stations (cervicothoracic, thoracolumbar) stitched together
Sagittal T1, T2, STIR throughout for marrow/cord survey
Axials targeted to areas of abnormality
Post-contrast sagittal/axial T1 for enhancing lesions and leptomeningeal disease

Series / Sequences

#	Series / Sequence	Plane	Weighting / Recon	Thickness	Notes
1	Sag T1 (whole spine)	sagittal	T1	3-4 mm	2-3 stations
2	Sag T2 (whole spine)	sagittal	T2	3-4 mm
3	Sag STIR (whole spine)	sagittal	STIR	3-4 mm	Marrow/cord edema, mets
4	Ax T2 targeted	axial	T2	3-4 mm	Through lesions/compression
5	Sag T1 post	sagittal	T1 +C	3-4 mm	Tumor/leptomeningeal
6	Ax T1 post targeted	axial	T1 +C	3-4 mm

Key points

Used to survey the full neuraxis; ensure no gaps between stations.
STIR is the workhorse for marrow metastatic survey.
Add contrast and post-contrast FLAIR/T1 for leptomeningeal/drop metastases (e.g., medulloblastoma, ependymoma).
Flag any cord compression urgently.

References

• ACR-ASNR-ASSR Practice Parameter for MRI of the Adult Spine
• Radiopaedia: Whole spine MRI
• ACR Appropriateness Criteria: Suspected Spine Metastases

Source: Researched — verify against your institution

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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.