3.0 t system

All patients underwent an MRI scan of the brain on a 3.0-T system (GE Medical Systems, Milwaukee, WI, United States) using an eight-channel phased-array head coil. The standard protocol for MS studies was performed including a conventional axial 2D dual-echo proton density (PD)-T₂-weighted imaging (T₂WI) [repetition time (TR) = 2,900 ms, echo time (TE)1 = 25 ms, TE2 = 93 ms, echo train length [ETL) = 12, matrix size = 256 × 192] and 2D fluid-attenuated inversion recovery (FLAIR) (TR = 2,050 ms, TE = 24 ms, TI = 750 ms, matrix size = 256 × 256). All axial scans were taken from the roof of the skull to the foramen magnum [slice thickness = 5 mm, slice skip = 0 mm, field of view (FOV) = 24 cm × 24 cm].
ESWAN data were acquired with eight echoes using the following parameters: TR = 60 ms, TE = 6 ms, number of excitation (NEX) = 0.75, FOV = 22 cm × 22 cm, matrix size = 448 × 320, receiver bandwidth = + 62.5 kHz, and flip angle = 20°. The sequence was acquired with 2-mm-thick contiguous sections and no space. All scans were oriented parallel to the anterior–posterior commissural (AC-PC) line with 56–64 locations on the middle sagittal plane and covered the entire brain area.

The MRI scans of all the ICC patients were performed using a 3.0-T system (GE Healthcare; Siemens Healthcare). A 16-channel phased-array torso coil was used for all measurements. The mpMRI sequences included fast low-angle shot T1-weighted imaging in/out-of-phase, breath-hold fat-suppressed turbo spin-echo T2WI, MRCP, DWI, and dynamic multiphase enhanced imaging. The contrast agent (Omniscan, GE Healthcare) was injected with a dose of 0.2 ml/kg at a rate of 3 ml/s and then immediately followed by a flush of 30 ml saline. The images in the arterial phase, portal venous phase, and delayed phase were obtained at 30, 60, and 180 s after injection of the contrast agent. The detailed MRI scanning parameters are shown in Table E1.

We collected the case data of neck symptomatic cases (include neck pain, shoulder pain, neck stiffness, upper limb pain or numbness) who sought care at Xijing hospital from 2017 to 2021. After excluding cervical spine fractures, tumors, and patients who had received cervical spine surgery, a total of 102 patients (64 males, 38 females, average age = 50.44 ± 10.63) were included in the study (all information of the patients was shown in Table S1). There were 27 cases in the ~45 group, 69 cases in the 46 ~ 65 group and 6 cases in the ~66 group. IDD severity was assessed by three blinded spine surgeons according to the Miyazaki grading system by images of MRI.¹¹ MRI was performed using a 3.0T system (GE) to obtain T2‐weighted images (repetition time, 2480 ms; echo time, 104 ms; field of view, 32 mm × 32 mm; slice thickness, 3.5 mm). FJD severity was assessed by the other three blinded spine surgeons according to the Pathria's grading system¹² according to images of CT. IVDs and FJs of three segments (C3‐C4, C4‐C5, and C5‐C6) were evaluated. Patients with moderate IDD (Grade 1–2) and severe FJD (Grade 3–4) were grouped into FJ severe degeneration group. And patients with moderate FJD (Grade 1–2) and severe IDD (Grade 3–5) were grouped into IVD severe degeneration group. The rest was classified as FJ and IVD degeneration group.