When – after >20 years in the "business" – I saw …

… for the first time, how nerves actually connect with the upper spinal cord.

 It happened

… when we acquired our – literally – first cervical-spine MR-images at 7 Tesla with RAPID Biomedical's signal antenna. 

 So, what's new?

When appreciating the many beautiful visualizations (STIR or DWI) of the nervous plexus in neck and shoulder – I apparently failed to notice that the nerve rootlets within the spinal canal were not nearly as well depicted as their extensions outside the spine – even though I did appreciate an occasional glimpse of an intra-spinal rootlet, say, in an axial T2-weighted spin-echo, in a balanced gradient-echo, or in a MEDIC image.

But it wasn't until this moment that the breathtakingly delicate arrangement of intra-spinal nerve rootlets (fila radicularia) revealed itself to me for the first time – with a positive contrast in three dimensions.

Anatomy

There is an anterior and a posterior vertical "ladder" of rootlets that emerge from the left as well as from the right side of the spinal cord. It is known that along the spinal cord, the rootlets branch off in regionally varying, but locally almost regular intervals – without systematic segmental organization. However, on their way outwards through the canal, they bundle up to meet at one of the few "exits" through one of the intervertebral foramina and, thus, present these beautiful fan-shaped arrangements in coronal views. 

How to image?

Julien Galley recently reported that the rootlets could successfully be visualized in a cohort of patients, who were clinically referred to a cervical-spine MRI examination. As a proof-of-concept, this was possible on both our open-access 3-Tesla and 7-Tesla MRI scanners. However, in the ideal case, the higher field strength (7 Tesla) allowed an encoding for a higher isotropic spatial resolution ([0.63 mm]3) with still acceptable signal intensity.

Question

Provided a high-quality visualization of the fila radicularia could be made sufficiently robust: can you think of a clinical workflow, where this could contribute to an improved patient treatment?

#SCMI

?#BalgristCampus

#Balgrist

#MedicalImaging

#musculoskeletal

#radiology

#research

#mri

#7Tesla