Spine MRI

What it does

Spine MRI reads lumbar, cervical, thoracic and whole-spine studies, among the highest-volume MRI exams in any department. The run labels every vertebra and disc first, flags transitional anatomy, and counts from C2 when a whole-spine sagittal or localiser is present, so each finding sits on the right level.

It returns a level table from C2–T1 and L1–S1: central canal, subarticular and foraminal stenosis grades, disc herniation type in Fardon 2014 nomenclature, Pfirrmann disc degeneration, Modic endplate changes and spondylolisthesis. Alongside the degenerative read, the run screens for the red flags that must not be missed: metastatic epidural compression with a Bilsky grade, cord compression or intramedullary signal, and acute vertebral fractures.

Intended use

Decision support for physicians reporting spine MRI: a consistent per-level grading where inter-reader variability is high, and a red-flag screen that marks urgent referral at Bilsky grade 2 or higher or with signs of myelopathy. Grades come with the level, the image and the measurement behind them.

Who it is for

General radiologists, teleradiologists and musculoskeletal or neuroradiologists, with results going to spine surgeons, neurosurgeons, pain physicians, oncologists and physiotherapists. Through the API, the level table drops into reporting templates and surgical planning software.

Accepted input

• DICOM MR studies (MR Image, Enhanced MR, Legacy Converted Enhanced MR) of one region or the whole spine, as a zip or by DICOMweb STOW-RS; NIfTI with a BIDS-style sidecar on the API.
• Sequences are recognised from acquisition tags and image content, not from series names.
• A prior study can be attached in prior_files for comparison.

Requirements

Requirement	Why
Sagittal T1 and T2	Level labelling, disc grading, foraminal grading, marrow signal
Axial T2 through the discs	Central canal and subarticular grading, herniation position
Sagittal STIR (or fat-suppressed T2)	Marrow oedema separates acute from chronic fractures and shows metastatic infiltration
Whole-spine sagittal or localiser	Reliable counting from C2 when anatomy is transitional
Whole-spine sagittal T1/T2/STIR with axials	Bilsky and SINS assessment across all levels

When a section's required sequence is missing, the result names the sequence instead of grading without it.

Optional context

The clinical question (radiculopathy, myelopathy, known malignancy, trauma, MS) and age go in clinical_context; they shape the guidance.

The result

Section	Content
Vertebrae and level labels	Instance masks of vertebrae, discs, canal and cord with level labels; transitional-anatomy flag
Degenerative level table	Per level: canal, subarticular and foraminal stenosis grade, herniation type, Pfirrmann, Modic, spondylolisthesis
Spinal cord	Cord mask, cross-sectional area per level, compression ratio, intramedullary T2 lesions (MS, injury, tumour)
Metastatic cord compression	Epidural tumour by level, Bilsky ESCC grade, MRI components of the SINS score
Vertebral fractures	Compression fractures, acute versus chronic by marrow oedema, benign versus malignant features, height-loss grade
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• DICOM: SEG for vertebrae, discs, canal and cord on the source series; SR TID 1500 for the level measurements; KOS key images and Encapsulated PDF.
• Nomenclature: Fardon 2014 lumbar disc nomenclature for herniation type.
• Grading: Pfirrmann (disc degeneration), Modic (endplates), Lee (foraminal stenosis), Schizas (central canal morphology), semi-quantitative height loss for compression fractures.
• Oncology: Bilsky epidural spinal cord compression scale and the Spinal Instability Neoplastic Score (SINS).
• Cord lesions: McDonald 2017 for MS lesions in the cord.

Level table

The result carries a level_table block: one row per level with every grade and its side, ready to import into a reporting template or a surgical registry.