Physician’s Guide

Practitioners are often faced with selecting the correct modality, most often the decision is between MRI and CT Scan. Some of the factors that can determine this are: area of complaint, presenting symptoms, and suspected pathology. We have put together a list to help as a reference in case there is a question to which modality would be best to order.

Area of Complaint	Presenting Symptoms	Suspected Pathology	Imaging Modalities Indicated
Head	Dizziness	Acoustic neuroma, multiple sclerosis, temporal lobe lesion, tumor, or stroke, sub or epidural hematoma, cyst	MRI: The most sensitive for suspected pathology listed CT: Less expensive than MRI but not as sensitive
Head	Seizures	Temporal lobe lesion, tumor, or stroke, multiple sclerosis, cerebrovascular accident, cyst	MRI: The most sensitive for suspected pathology listed CT: Less expensive than MRI but not as sensitive. Exception: CT is more sensitive in acute stage (1st 3 days) post cerebral hemorrhage.
Head	Localized pain or headaches	Tumor, abscess, arteriovenous malformation, trauma, cyst	MRI: Most Sensitive CT: Less expensive and less sensitive. Exception: CT is more specific for calcified tumors.
Head	Non-localized headache	Tumor or other space occupying lesion, mastoiditis sinusitis, hydrocephalus, cyst.	MRI: Most Sensitive CT: Less expensive and less sensitive.
Head	Behavioral changes	Tumor or other space occupying lesion, Cerebrovascular Accident (CVA), cyst or multiple sclerosis.	MRI: The most sensitive for Tumor or Multiple Sclerosis. CT: Less sensitive for hemorrhage in acute stage 2st 3 days post hemorrhage.
Head	Post Trauma or surgery	Subdural or Epidural Hemmatoma, or other Hemorrhage, Infection, Abscess.	MRI: Most sensitive for Hemorrhage in Subacute Stage (4 to 10 days post trauma) or Chronic Stage (10 days or more post trauma), for infection or abscess. CT: Most sensitive for hemorrhage in Acute Stage 1st 3 days post trauma. .
Head	Sensory changes	Acoustic Neuroma, Occipital Lobe Lesion, Optic Chiasm or Optic Nerve Lesion, Meningioma, Cyst, Olefactory Nerve Lesion. .	MRI: Most Sensitive CT: Less expensive and less sensitive. Exception: CT is more specific for calcifying lesions.
Head	History of Cancer	Metastasis	MRI: Most Sensitive CT: Less sensitive except for calcifying lesions.
Head	Amenorrhea or Lactation	Prolactinoma, or other Pituitary Tumor	MRI: Most Sensitive CT: Less sensitive due to scatter artifact from Sella Turcica.
Cervical	Unilateral or Bilateral symptomology of neck or upper extremities.	Arthritic Hypertrophy, Herniated Nucleus Pulposus (HNP), bulging Anulus Fibrosus, Cord Tumor, Syringomylia, Stenosis of Spinal Canal of Foraminal Openings, Non-displaced Fracture, Multiple Sclerosis (MS)	MRI: Most sensitive for various soft tissue structures-discs, canal contents, tumors or MS. CT: More sensitive for bony structures or for non-displaced fracture.
Cervical	History post trauma or surgery.	HNP, Recurrent HNP versus scar tissue, Ligamentous Tearing, Non-displaced Fracture, Syringomylia, Infection, Recurrent Cord Tumor.	MRI: Most sensitive for Syringomyelia, HNP, or Post Surgery Evaluation. CT: More sensitive for non-displaced fracture. Video Flouroscopy: Most sensitive for joint motion abnormalities post trauma.
Cervical	Loss of range of motion or excessive motion of individual motor units.	Ligamentous Tearing or Laxity, Muscle Spasm.	MRI: Most sensitive for soft tissue structures and inflammatory reactions. CT: Most sensitive for bone pathology. Video Flouroscopy: Most sensitive for joint motion abnormalities related to ligamentous injury.
Cervical	History of Cancer or Systemic Disease affecting bone (Pagets, Lupus, etc.)	Metastasis to Spinal Cord, or bony structures, marrow changes secondary to systemic disease, pathological fracture from metastasis.	MRI: The most sensitive for evaluation of Metastasis or marrow changes a known area. CT: Sensitive for bony detail. Nuclear Medicine: Offers whole body coverage for initial localization of metastasis to bone, best for initial screening.
Thoracic	Unilateral or Bilateral Symptomology of trunk or lower extremities	Arthritic Hypertrophy, HNP, Bulging Anulus, Cord Tumor, Syringomyelia, Stenosis of Canal or Foraminal Openings, Compression Fracture.	MRI: Most sensitive for various soft tissue structures-discs, canal contents, tumors, syringomyelia. CT: More sensitive for bony structures. .
Thoracic	History Post Trauma or Surgery.	Compression Fracture, Syringmyelia, Recurrent HNP versus Scar Tissue, Recurrent Cord Tumor, Infection.	MRI: Most sensitive for various soft tissue structures. CT: Best for Bony Details.
Thoracic	History post cancer or Systemic Disease affecting bone (Pagets, Lupus, etc.)	Metastasis to Spinal Cord or Bony Structures, Marrow changes secondary to systemic disease, pathological fracture.	MRI:Most sensitive for evaluating soft tissue structures and marrow. CT: Best for Bony Details. Nuclear Medicine: Offers whole body coverage for initial localization of metastasis disease in bone.
Lumbar	Unilateral or Bilateral Symptomology of lower back, pelvis, lower extremities, or incontinence.	Arthritic Hypertrophy, HNP, Bulging Anulus, Conus or Cauda Equina Tumor, Stenosis of Canal or foraminal openings, Compression Fracture, Abdominal Aortic Aneurysm, Tethered Cord.	MRI:The most sensitive for soft tissue structures, easily identifies aneurysms. CT: Best for bony details (bulging anulus versus osteopathic growth) also visualizes aneurysms well.
Lumbar	Compression Fracture, Neural Canal or Foraminal Stenosis, Infection, Recurrent HNP versus scar tissue, recurrent conus or cauda equina tumor.	Compression Fracture, Neural Canal or Foraminal Stenosis, Infection, Recurrent HNP versus scar tissue, recurrent conus or cauda equina tumor.	MRI:The most sensitive for soft tissue evaluation post surgery or trauma. CT: Best for bony detail.
Lumbar	History of cancer or systemic disease affecting bone (Pagets, Lupus, etc.)	Metastasis to Spinal Cord or Bony Structures, Pathological fracture, marrow changes secondary to systemic disease.	MRI:Most sensitive for evaluating soft tissue structures, best for follow-up evaluation of known mets or marrow abnormalities. CT: Best for bony detail. Nuclear Medicine: Offers whole body coverage, best for initial screening.
Shoulder	Chronic Dislocation	Glenoid Labrum Tear, Degenerative Joint Disease.	MRI: Most accurately depicts glenoid labrum glenoid fossa.
Shoulder	Pain and Weakness, Decreased range of motion, history of arthritis or trauma.	Full or partial thickness rotator cuff tear, impingement syndrome, fracture, synovial cysts, neoplasm, effusion, injection.	MRI:Most sensitive for partial thickness tears, same sensitivity as arthrography for full thickness tears, most sensitive for synovial cysts, impingement syndrome, neoplasm, effucion, infection Arthrography: equal sensitivity with MRI for full thickness tears, less sensitive for partial thickness tears.
Hip	History of cancer or systemic disease affecting bone (Pagets, Lupus, etc.)	Metastatic tumor, occult fracture, marrow changes to secondary systemic disease.	MRI:Highly sensitive to metastatic lesions and marrow changes, can evaluate fractures in multiple planes. CT:More sensitive for bony detail. Nuclear Medicine:Offers whole body coverage best for initial localization of metastatis disease in bone.
Hip	Unilateral or Bilateral pain, decreased range of motion, history of trauma or surgery.	Avascular necrosis, tummor, degenerative joint disease, occult fracture.	MRI:The most sensitive imaging modality for detecting in schemic necrosis in bone, only modality that images hyaline cartilage. NOTE: Hip prosthesis patients are safe to scan by MRI degradation of images may or may not occur depending on content of prosthesis. CT:Good bony detail, sensitive for occult fractures.
Wrist, Elbow, Ankle, and Foot	Pain, decreased range of motion, history of trauma or prior surgery, history of arthritis.	Vascular necrosis, intra-articular loose bodies, transchondral fracture, cyst formation, tendon or ligament tearing, soft tissue or bony tumor, fracture non-unions.	MRI:The most sensitive for soft tissue evaluation and chronic fractures, multiplanar evaluation advantages. XRAY: Best for bony detail and morphology. ..
Chest: Lungs and Heart	History of cancer or Hodgkin’s disease..	Metastasis, Lymphatic Involvement.	MRI:Less sensitive than CT, but good for followup if CT is equivocal, images substernal lymphadenopathy well – no scatter artifact. CT: Equivalent to or more sensitive than MRI, less affected by peristaltic, respiratory and pulsatile motion, best for initial screen. Ultrasound: Offers high resolution imaging of lesions, good initial screen if small lesions are suspected.
Abdomen: Liver, Spleen, Pancreas, and Kidneys	History of cancer, loss of function, chronic or acute, localized or non-localized abdominal pain.	Primary or Metastatic, Tumor Involvement, benign cyst, hemochromatosis, infection.	MRI: Equivalent to or less sensitive than CT, good for follow-up when CT is equivocal, best for hemochromatosis. CT: Equivalent to or more sensitive than MRI, less affected by peristaltic, respiratory pulsatile motion, best for initial screen. Ultrasound: Offers very high resolution imaging of lesions, good initial screen if small lesions are suspected.
Pelvis: Bladder, Uterus, Ovaries, Prostate	History of benign masses or cancer, chronic or acute localized or non-localized pelvic pain.	Primary or metastatic, tumor involvement, benign tumor or cyst, infection.	MRI: Best at evaluating wall invasion by Tumor growth best for follow-up after tumor sites have been localized with CT. CT: Good for initial screening and localization of gross tumors.. Ultrasound: Best for initial screening of pelvic lesions, real time imaging offers best structure identification, very high resolution capabilities.

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