Update: December 2018
More than 80% of the adult population suffers to one degree or another.
spinal disorders. Most of them are related to
natural aging processes and physical overloads.
A smaller proportion are injuries, inflammatory changes,
Symptoms for which the spine should be examined:
- Pain in the neck, chest, between the shoulder blades, in the lumbosacral
- The spread of pain in the arms, legs, buttocks, genital
- Spinal curvature;
- Headache, dizziness, fainting;
- Numbness of the neck, limbs;
- Impaired control of urination and bowel movements;
- Paresis and paralysis;
- Pain in the chest and abdomen in the absence of internal pathology
If until recently the main research method was
x-rays, now more and more doctors recommend CT and MRI
spine. This raises a logical question – which of
these methods are better.
MRI provides clearer information on the state of soft tissue, but,
for example, calcium in the bones does not “see” at all. CT allows
examine bone tissue in more detail.
В чем difference между MRI and КТ?
Outwardly, these methods are very similar, but they are based on absolutely
разных физических принципах.
- Компьютерная томография – это вариант
x-ray examination. X-rays fan
diverge from the radiation source, pass through the body and
caught by a special sensor that converts them into
electrical signals. The received data is processed
computer programs to obtain layered images
и возможностью построения трехмерной модели органа. Source and
the radiation receiver is in constant coupling and synchronously
moving in a circle and in a spiral (with multislice CT).
This makes it possible to completely scan the patient’s body and
detect even minimal changes.
X-rays when passing through organs gradually
fade out. Moreover, the denser the structure, the more it absorbs
radiation and the weaker the output signal will be.
Результат КТ зависит от физических свойств тканей, точнее
from their density. As with conventional radiographs, CT scan is good.
visible bones and other dense structures, as well as cavities.
- МРТ основано на явлении ядерно-магнитного
resonance in the test object. Under the influence of a magnetic field and
radiofrequency impulses hydrogen atoms contained in the body,
change their spatial orientation. This process
accompanied by the release of energy that is recorded and
convert special sensors. After processing received
Information computer generated images.
Unlike CT, MRI is not based on physical characteristics.
tissues, and their chemical composition (hydrogen content). Because
большая часть атомов водорода в теле человека входит в состав
water, the pictures show better structures with high
fluid content. For bone research this method is not
What to choose?
Definitely say that a CT scan or MRI of the spine is better.
Каждый из этих методов имеет свои показания и ограничения.
Before making a choice in favor of a particular method, you must
decide which is more important to get – the image of bones or soft
Компьютерная томография –наиболее достоверны метод для
studies of the vertebrae themselves: their bodies, transverse and spinous
processes, intervertebral joints, discs and spinal
channel. The information content of CT can be increased
- Anomalies of the spine;
- Diagnosis and differential diagnosis of tumors and
- Diagnosis of metastases to the spine in breast cancer,
- Back injuries, clarification of the nature of bone injuries in complex
anatomical zones (damage to the lateral masses of the sacrum, fractures
spine), identifying ruptures of hollow organs associated with
- Refinement of the state of the spinal canal and its contents
with herniated intervertebral discs;
- Evaluation of the state of the spine after surgery;
- Analysis of bone density in osteoporosis;
- Compression fractures in osteoporosis and myeloma
- Determining the severity of degenerative changes
(displacement of adjacent vertebrae, change in the height of the intervertebral
discs, dystrophic changes in the vertebrae themselves and intervertebral
joints, protrusions and hernia);
- Establishing the causes of compression of the spinal cord;
- Back pain of unknown etiology.
Despite the fact that spinal hernias are visible on CT, with
suspicion of them is still better to do an MRI.
In osteoporosis, CT is also of secondary importance, “golden
the standard for its diagnosis is x-ray densitometry.
On informativeness, this method is not inferior to CT, and the radiation load
below almost 100 times.
- The ability to simultaneously scan bones, internal
- The study takes only a few seconds, which is especially
important in urgent situations, when examining patients with
claustrophobic pronounced pain syndrome.
- The absence of absolute contraindications. Restrictions exist
only for pregnant women and young children due to
additional radiation exposure. These categories survey
held for health reasons.
- Suitable for people with pacemakers, insulin pumps,
endoprostheses and other metal structures in the body.
- Significantly cheaper than MRI.
- More accurate images of bone tissue.
- A short study takes a few minutes,
difference from MRI is very fast.
- Health hazard due to high radiation exposure. She is
depends on the volume of research and the number of sections obtained. With
the scan of the spine, it is an average of 5 – 6
mSv, which is comparable with natural exposure,
received in 2 years. For comparison, with conventional radiography
Radiation load is in the range of 0.2 – 0.7 mSv.
- The study is carried out only on prescription.
- Does not provide information about the functional state of tissues and organs
only about their structure.
- Do not perform CT often because of the risk of exposure.
- You can not conduct an examination of children, pregnant women,
MRI – highly informative and safe method of radiation
diagnostics. Он позволяет выявлять изменения в спинном мозге и
его оболочках, нервных корешках и спинномозговых нервах, в
межпозвонковых дисках и околопозвоночных тканях.
- Suspected intervertebral disc hernia,
- Assessment of the degree of compression of the nerve roots and spinal
- Malformations of the spinal cord
- Primary spinal cord tumors and metastases,
- Heart attack and other vascular diseases of the spinal cord,
- Inflammation of the spinal cord and its membranes
- Diagnosis of demyelinating diseases (scattered
- Assessment of the state of the spinal cord after injury
- Spinal cord monitoring after operative
- no radiation exposure;
- possibility of early diagnosis of tumors (determines the formation of
less than 2 cm in diameter);
- high information content even without contrasting;
- completely safe method to examine children and
- high accuracy of information, three-dimensional image;
- can often be used for diagnosis, in contrast to CT;
- ошибок при сканировании практически нет;
- for the study of blood flow does not require contrast;
- during the examination of intervertebral hernia great information
evaluation of damage to the central nervous system.
- The need for a long time to lie still;
- The study averages from 15 to 40 minutes. it
затрудняет диагностику у больных с клаустрофобией, с
severe spinal deformity and pain
- Absolutely contraindicated for people in whose body there are
metal elements and electronic devices (pacemakers,
metal implants, hemostatic clips, foreign
тела и др.);
- Even the slightest movement reduces image quality;
- The high price of the survey.
Errors in the choice of method
The high popularity and wide availability of CT and MRI led to
тому, что пациенты стали обследоваться самостоятельно. BUT
the reason for going to a doctor is often not complaints, but
tomography conclusion. Such surveys, in most
cases are not just meaningless, but even dangerous.
Гипердиагностика ведет к назначению ненужного treatment,
увеличению тревожности и развитию неврозов у самого
the patient and his family.
Typical errors in the survey:
Check “just in case”
КТ и МРТ выявляют даже минимальные изменения в тканях,
interpret which is almost impossible. The only thing that
may recommend a radiologist – this observation in the dynamics. With
re-scanning these violations in most cases not
determined at all, or detected in other places. The more
the patient repeats the examination, the more difficult it is to convince him
MRI as the first research method
First, the diagnosis of most spinal diseases
based on neurological examination and simple radiography. MRI and
КТ показаны при подозрении на тяжелые, угрожающие жизни
заболевания (опухоли, абсцессы), и в диагностически сложных
Second, spinal changes on MR images are often
non-specific, therefore, to establish an accurate diagnosis based on one
Only the conclusion of an MRI is impossible. With прохождении томографии,
больным всегда рекомендуют иметь при себе результаты всех
�”Inspection for the sake of examination”
Tomography does not make sense if its result does not affect
further treatment tactics. MRI is needed only when
Considers the question of surgery.