3D T2w SPACE sequences have been used for imaging of the knee, lumbar, and cervical spine and have been evaluated in comparison with conventional 2D sequences, with a focus on structure visibility and comparison to conventional sagittal and axial sequences in the cervical spine. 3D sequences allow for reformation in arbitrary planes, including perpendicular to the axis of the neural foramina (i.e., sagittal oblique) and adaptable to each level, and offer coverage of the foramina of both sides and the spinal canal in a single sequence at reasonable acquisition times. While sagittal oblique T2w sequences have been shown to permit good evaluation of the cervical neural foramina, these sequences are added to the conventional sequences, thus increasing examination time. An ideal protocol would allow excellent visualization of the spine, its contents and its surroundings, combined with a fast acquisition time to avoid patient discomfort and motion and provide enough imaging slots in a context of high demand. No standard imaging protocol has been established for the examination of the cervical spine, and protocols vary among institutions. Oblique (or “angled”) sagittal T2w sequences have been shown to be more accurate in the evaluation of the cervical neural foramina than “conventional” sagittal and axial sequences, and their use may alter surgical recommendations. This has led to the use of oblique projections for radiographic evaluation, oblique reconstructions of CT acquisitions, and oblique sagittal MRI sequences (mostly T2w) angled about 45° for a better, in-plane representation of the foramina. While standard examination planes-mostly sagittal and axial-allow for evaluation of both spinal canal contents and neural foramina in the lumbar spine, visualization of the cervical neural foramina and their contents is rendered more difficult by their oblique orientation, with angles of about 45° to the sagittal and 10–15° (inferiorly) to the axial plane. MRI, a non-invasive and non-irradiating technique with excellent visualization of the spine and spinal cord, has become the method of choice for the imaging evaluation of the spine. ConclusionģD T2w SPACE is comparable with sagittal oblique 2D T2w TSE in the evaluation of cervical neural foramina.ĭegenerative diseases of the spine are highly prevalent and account for a large proportion of cases examined in daily clinical practice. Stenosis grades were comparable between sequences (mean 1.1–2.6 of 4), with slightly higher values for 3D T2w SPACE at some levels (difference ≤ 0.3 points). Visibility of most structures was rated good to excellent on both sequences (mean visibility scores ≥ 4.5 of 5), though neuroforaminal contents were better seen on sagittal oblique T2w TSE (mean scores 4.1–4.6 vs. Interreader agreement was evaluated by weighted κ. Results of the sequences were compared by Wilcoxon matched-pairs tests. Imaging sets were assessed for structure visibility and foraminal stenosis by two independent readers. Image homogeneity of the sequences was evaluated. Sixty consecutive patients who underwent MRI of the cervical spine with sagittal oblique 2D T2w TSE and 3D T2w SPACE sequences were included. We set out to compare 3D T2w SPACE sequences with sagittal oblique reformations and sagittal oblique 2D T2w TSE sequences for the evaluation of cervical foraminal visibility and stenosis. 3D T2-weighted sequences can be reformatted in arbitrary planes, including the sagittal oblique. While sagittal oblique T2-weighted sequences permit good evaluation of the cervical neuroforamina, all segments may not be equally well depicted on a single sequence and conspicuity of foraminal stenosis may be limited. The oblique orientation of the cervical neural foramina challenges the implementation of a short MRI protocol with concurrent excellent visualization of the spine.