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"Rule Out HNP" on Cervical MRI: Clinical Meaning and Workflow

"Rule out HNP" on a cervical MRI order means the referring clinician suspects a herniated nucleus pulposus (HNP)—commonly called a slipped or herniated disc—as the cause of the patient’s symptoms and wants imaging to confirm or exclude it.

HNP Pathophysiology

The nucleus pulposus (gelatinous core) extrudes through a tear in the annulus fibrosus, potentially compressing the spinal cord or nerve roots.

Typical Clinical Scenario

Radicular arm pain (dermatomal), paresthesia, weakness
Neck pain with radiation, worsened by Valsalva/cough
Myelopathy signs (gait disturbance, hyperreflexia, bowel/bladder changes) if cord compression

MRI Protocol for HNP

Sagittal T1/T2: Disc height, hydration, herniation extent
Axial T2/STIR: Nerve root compression, foraminal stenosis
Optional: T1 post-contrast (post-op, infection, tumor)

Reporting Terminology

Clinical Correlation

Asymptomatic herniations common (30%+ adults).
Findings must match symptoms for surgical consideration.
"Rule out" implies pre-test probability is significant; negative MRI shifts diagnosis.

Precise language guides radiologist focus and clinical decision-making.

Human Papillomavirus (HPV) - Related Articles

Term	Definition
Disc bulge	Circumferential extension >50% circumference
Protrusion	Focal extension, base > apex
Extrusion	Apex > base; may migrate
Sequestration	Fragment detached from parent disc