MRI Anatomy Flashcards · Neuro

C-Spine Anatomy

Learn to identify every labeled structure on a C-Spine MRI, plane by plane.

Studying as a guest, so progress saves on this device only.

C-Spine anatomy, structure by structure

Cervical spine MRI is one of the most common spine studies a technologist runs, and reading it well starts with knowing the normal anatomy cold. This reference walks through every structure in our C-Spine flashcard deck across the two standard planes used here (sagittal and axial), with a plain-language definition, how each structure looks on MRI, and the pathology you will actually run into at the scanner.

C1-C2 (atlas and axis)

The first two cervical vertebrae carry their own named anatomy. The midline sagittal is the workhorse view for the dens and the arches of the atlas.

Anterior Arch of Atlas

The small bony arch at the front of C1 (the atlas) that articulates with the front of the dens to form the median atlanto-axial joint.

On MRI: Seen as a small rounded cortical bone segment in front of the dens on the midline sagittal, with bright fatty marrow on T1 and a thin dark cortical rim; a sliver of CSF or joint space sits between it and the dens.

Common pathology: The atlanto-dental interval here widens with transverse ligament disruption or rheumatoid pannus, both of which raise the risk of cervicomedullary compression.

Tip: On a midline sagittal, find the dens first, then the little block of bone immediately anterior to it is the anterior arch of the atlas.

Posterior Arch of Atlas

The bony arch at the back of C1 (the atlas) that completes the ring of the first cervical vertebra behind the spinal cord.

On MRI: A short curved segment of cortical bone with bright marrow on T1 at the back of the C1 ring on midline sagittal, sitting behind the cord and dorsal CSF space.

Common pathology: A common site of C1 (Jefferson-type) fractures and a landmark for assessing the craniocervical junction and posterior CSF space.

Dens

The upward bony peg of C2 (the axis), also called the odontoid process, that projects into the ring of C1 and acts as the pivot for head rotation.

On MRI: A vertical tooth-shaped projection rising from the C2 body on midline sagittal, with bright marrow on T1 and a dark cortical margin; the anterior arch of the atlas sits just in front of its tip.

Common pathology: Odontoid (type II) fractures are a key trauma finding, and marrow edema or erosion here can indicate fracture, infection, or rheumatoid involvement.

Tip: The dens is the only vertical bony peg at the top of the column; trace the C2 body upward and the spike that points toward the skull base is the dens.

Cervical vertebral levels

Counting levels accurately is a core technologist skill. On the midline sagittal you count vertebral bodies down from the dens to confirm the level of any finding.

C2

The second cervical vertebra, also called the axis, identified by the dens projecting upward from its body.

On MRI: The first full vertebral body below C1 on midline sagittal, recognized by the dens rising from its top; bright fatty marrow on T1 with a thin dark cortex.

Common pathology: Anchors level counting for the whole cervical spine; the C2 body and dens junction is a frequent trauma and metastatic site.

C3

The third cervical vertebra, the first of the typical mid-cervical bodies below the axis.

On MRI: The vertebral body directly below C2 on midline sagittal, with marrow signal that follows the rest of the column; the C2-C3 disc sits just above it.

Common pathology: Mid-cervical degenerative change and disc disease begin to appear at this level and below.

C4

The fourth cervical vertebra, a typical mid-cervical body.

On MRI: Counted as the next body below C3 on midline sagittal; bright fatty marrow on T1, intermediate on T2, with the bright nucleus of the adjacent discs on T2.

Common pathology: Degenerative spondylosis and disc-osteophyte complexes are common across the mid-cervical levels including C4.

C5

The fifth cervical vertebra, a typical mid-cervical body.

On MRI: The body below C4 on midline sagittal, sharing the same marrow signal pattern as the levels above and below it.

Common pathology: C5-C6 is one of the most common levels for degenerative disc disease and foraminal narrowing on cervical MRI.

C6

The sixth cervical vertebra, a lower mid-cervical body.

On MRI: Counted downward to the second-to-last cervical body on midline sagittal; normal marrow signal with the C5-C6 and C6-C7 discs framing it.

Common pathology: Degenerative change, disc herniation, and uncovertebral spurring frequently involve C6 and its adjacent levels.

C7

The seventh and lowest cervical vertebra, marking the transition to the thoracic spine at the cervicothoracic junction.

On MRI: The last cervical body before the T1 level on midline sagittal; its long spinous process (the vertebra prominens) helps confirm the count.

Common pathology: The cervicothoracic junction is a blind spot for plain films, so MRI level confirmation at C7-T1 matters for fractures and metastases.

C6-C7

The intervertebral disc between the C6 and C7 vertebral bodies, one of the lower cervical motion segments.

On MRI: A disc space between the C6 and C7 bodies on midline sagittal; a healthy nucleus is bright on T2, while a degenerated, desiccated disc loses that bright signal and narrows.

Common pathology: A common level for disc herniation and degenerative narrowing that can impinge on the exiting nerve root or the cord.

Vertebral body and posterior elements

Each vertebra is a body in front and a bony arch behind. The axial view is the best plane for the posterior elements that surround and protect the cord.

Vertebral Body

The large weight-bearing block at the front of each vertebra that stacks to form the spinal column.

On MRI: A rectangular block of bone on sagittal and a rounded block on axial; fatty marrow is bright on T1 and intermediate on T2, bounded by a thin dark cortical rim.

Common pathology: Compression fractures, metastatic marrow replacement (dark on T1), and discitis-osteomyelitis (marrow edema with endplate destruction) are key body findings.

Tip: On T1, normal vertebral body marrow should be brighter than the adjacent disc and cord; focal dark marrow on T1 is a red flag for tumor.

Spinous Process

The bony projection pointing backward from the midline of the vertebral arch, the bump you can palpate down the back of the neck.

On MRI: The most posterior midline bony spike on sagittal and the back tip of the bony ring on axial, with bright marrow on T1 and a dark cortical edge.

Common pathology: Clay-shoveler avulsion fractures and a useful midline landmark for confirming true midline on sagittal images.

Lamina

The flat plate of bone on each side of the vertebral arch that connects the transverse process to the spinous process and forms the back wall of the spinal canal.

On MRI: A pair of bony plates roofing the spinal canal on axial, with marrow signal on T1 and a dark cortical margin, meeting in the midline at the spinous process.

Common pathology: Removed or thinned surgically in laminectomy/laminoplasty; fractures here can occur in cervical trauma.

Transverse Process

The lateral bony projection on each side of the vertebra that serves as an attachment point for muscles and ligaments.

On MRI: A wing of bone projecting laterally on each side on axial images, carrying the transverse foramen within it in the cervical spine.

Common pathology: Transverse process fractures and a landmark for locating the vertebral artery and exiting nerve roots.

Transverse Foramen

The small opening within each cervical transverse process. The vertebral vein passes through all cervical levels, while the vertebral artery ascends through the foramina from C6 up to C1 and usually does not pass through the C7 transverse foramen. It is a feature unique to the cervical spine.

On MRI: A small round hole in the transverse process on axial, with the vertebral artery seen inside it as a dark flow void on standard spin-echo images and bright on flow-sensitive sequences.

Common pathology: The vertebral artery running through it can be injured in cervical trauma; vertebral artery dissection or occlusion is assessed at this location.

Tip: Find the small paired holes in the lateral bony wings on axial; the dark dot inside each is the vertebral artery in the transverse foramen.

Inferior Articular Process

The downward-facing bony surface of the facet joint that articulates with the superior articular process of the vertebra below.

On MRI: Part of the facet (zygapophyseal) joint seen on axial at the back-lateral corners of the bony arch, with a thin bright cartilage and joint line between the paired processes.

Common pathology: Facet joint arthrosis and hypertrophy here narrow the neural foramen and contribute to nerve root impingement.

Spinal cord and canal

The reason most cervical MRIs are ordered. CSF is dark on T1 and bright on T2, which makes the cord stand out clearly against the surrounding fluid.

Spinal Cord

The cord of nervous tissue running through the spinal canal that carries motor and sensory tracts between the brain and the body.

On MRI: A smooth ribbon of intermediate-signal tissue running down the canal on midline sagittal, surrounded by bright CSF on T2; best assessed for caliber and signal on sagittal T2.

Common pathology: Cord compression from disc or osteophyte, demyelination (MS), and edema or myelomalacia show up as bright T2 signal within the cord.

Tip: On sagittal T2 the cord should be a uniform gray band inside a bright CSF column; focal bright signal in the cord is abnormal.

Foramen Magnum

The large opening at the base of the skull where the brainstem (medulla) becomes the spinal cord.

On MRI: The bony ring at the top of the cervical study on midline sagittal where the medulla transitions into the cord; assess the cerebellar tonsil position relative to it.

Common pathology: Chiari I malformation (tonsils more than 5 mm below the foramen), foramen magnum meningiomas, and basilar invagination.

Frequently asked questions

What structures are seen on a cervical spine MRI?

A standard C-spine MRI shows the C1-C2 anatomy (the anterior and posterior arches of the atlas and the dens of the axis), the cervical vertebral bodies from C2 through C7 and their intervertebral discs, the posterior elements (spinous process, lamina, transverse process, transverse foramen, and articular processes), and the spinal cord within the canal from the foramen magnum down. This page labels each one with its MRI appearance.

Which planes are used for cervical spine MRI anatomy?

Cervical spine MRI is read primarily on sagittal and axial planes. The midline sagittal is best for orientation and level counting and shows the dens, vertebral bodies, discs, and the cord in one view, while axial images are best for the posterior elements, the transverse foramina, the facet joints, and the cord in cross section.

How do you count cervical vertebral levels on MRI?

On the midline sagittal, start at the dens to identify C2, then count each vertebral body downward to C7 at the cervicothoracic junction. Confirming the level this way is how technologists and radiologists pin a disc herniation or fracture to the correct segment, such as C5-C6 or C6-C7.

What runs through the transverse foramen in the cervical spine?

Each cervical transverse process contains a transverse foramen. The vertebral vein runs through all cervical levels, while the vertebral artery passes through the foramina from C6 up to C1 (it usually does not traverse the C7 foramen). It is unique to the cervical spine. On axial MRI the artery appears as a dark flow void inside the foramen on standard spin-echo images, which is why this landmark matters when assessing vertebral artery injury or dissection after neck trauma.

Do I need an account to use these C-Spine MRI flashcards?

No. The interactive flashcards and this full labeled reference are open to use, with no account required to start. Creating an account lets you save your progress across devices and track which packs you have mastered.

Tesla MR Institute

Training to become an MRI technologist?

These flashcards come from our MRI tech program — learn online and train at a clinical site near you, in 12 to 18 months.

Explore the program