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Peer-reviewedCC BYAJNR: American Journal of Neuroradiology

Advanced Spine Imaging: Technical Updates and Practice Recommendations

  • Ajay A. Madhavan1
  • Rami W. Eldaya2
  • Lubdha M. Shah3
  • Atin Saha4
  • Kyung K. Peck4
  • Vinil Shah5
  • Maria Gule-Monroe2
  • Lauren Clough Pringle6
  • Mai-Lan Ho6
6 affiliations
  1. 1From the Duke University Medical Center (A.A.M.), Durham, North Carolina
  2. 2MD Anderson Cancer Center (R.W.E., M.G.-M.), Houston, Texas
  3. 3University of Utah (L.M.S.), Salt Lake City, Utah
  4. 4Memorial Sloan-Kettering Cancer Center (A.S., K.K.P.), New York City, New York
  5. 5University of California, San Francisco (V.S.), San Francisco, California
  6. 6University of Missouri (L.C.P., M.-L.H.), Columbia, Missouri
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Abstract

Advanced spine imaging has historically lagged behind brain and neck imaging for implementation into clinical practice. This is largely due to unique technical challenges including rectangular FOV, anatomic curvature, small cross section, multiple tissue interfaces, physiologic motion, and surgical hardware. For common indications such as low back pain, advanced imaging may not be necessary for routine care. However, for complex problem-solving, improved anatomic and functional spine assessment can have profound impacts on patient diagnosis, interventional planning, and outcomes. Advanced techniques can sensitively and quantitatively interrogate vertebrae, intervertebral discs, spinal canal, neural foramina, spinal cord, and nerves. This comprehensive review from the American Society of Spine Radiology Education and Standards Committee synthesizes technical principles and applications of advanced spine imaging for routine clinical use, complex problem-solving, and ongoing investigation. We present a didactic categorization of diffusion, perfusion, parametric, CSF, dynamic, anatomic, metabolic, functional, and miscellaneous techniques. Each section provides a high-level summary of technical background, key advantages and disadvantages, clinical readiness, and recommended use cases with correlative imaging examples.

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Cite

BibTeXRIS
BibTeX
@article{madhavan2026advanced,
  title = {{Advanced Spine Imaging: Technical Updates and Practice Recommendations}},
  author = {Ajay A. Madhavan and Rami W. Eldaya and Lubdha M. Shah and Atin Saha and Kyung K. Peck and Vinil Shah and Maria Gule-Monroe and Lauren Clough Pringle and Mai-Lan Ho},
  journal = {AJNR: American Journal of Neuroradiology},
  year = {2026},
  month = nov,
  doi = {10.3174/ajnr.a9314},
  url = {https://doi.org/10.3174/ajnr.a9314},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Advanced Spine Imaging: Technical Updates and Practice Recommendations
AU  - Ajay A. Madhavan
AU  - Rami W. Eldaya
AU  - Lubdha M. Shah
AU  - Atin Saha
AU  - Kyung K. Peck
AU  - Vinil Shah
AU  - Maria Gule-Monroe
AU  - Lauren Clough Pringle
AU  - Mai-Lan Ho
PY  - 2026
DA  - 2026/11/06
JO  - AJNR: American Journal of Neuroradiology
DO  - 10.3174/ajnr.a9314
UR  - https://doi.org/10.3174/ajnr.a9314
AB  - Advanced spine imaging has historically lagged behind brain and neck imaging for implementation into clinical practice. This is largely due to unique technical challenges including rectangular FOV, anatomic curvature, small cross section, multiple tissue interfaces, physiologic motion, and surgical hardware. For common indications such as low back pain, advanced imaging may not be necessary for routine care. However, for complex problem-solving, improved anatomic and functional spine assessment can have profound impacts on patient diagnosis, interventional planning, and outcomes. Advanced techniques can sensitively and quantitatively interrogate vertebrae, intervertebral discs, spinal canal, neural foramina, spinal cord, and nerves. This comprehensive review from the American Society of Spine Radiology Education and Standards Committee synthesizes technical principles and applications of advanced spine imaging for routine clinical use, complex problem-solving, and ongoing investigation. We present a didactic categorization of diffusion, perfusion, parametric, CSF, dynamic, anatomic, metabolic, functional, and miscellaneous techniques. Each section provides a high-level summary of technical background, key advantages and disadvantages, clinical readiness, and recommended use cases with correlative imaging examples.
SN  - 0195-6108
SN  - 1936-959X
ER  -