Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients

Tewari, M K; Gifti, Difender S.; Singh, Paramjit; Khosla, Virender K.; Mathuriya, S. N.; Gupta, Sunil; Pathak, Ashis

doi:10.1016/j.surneu.2004.05.042

Cited by 108 publications

(90 citation statements)

References 31 publications

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“…3 In this study, spinal cord oedema was the most common (60%) change noted in patients with SCIWORET and cord contusion was encountered in 18%. This differs from observations of Tewari et al 11 who reported a frequency of cord contusion of 32% and cord oedema in only 5%. One possible reason for this difference may be the variability in interpretation of the more subtle MRI changes in the spinal cord by different radiologists.…”

Section: Discussioncontrasting

confidence: 98%

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Cervical spinal cord injuries without radiographic evidence of trauma: a prospective study

et al. 2013

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Study design: Prospective study. Objectives: In a prospective study, 45 consecutive cases of cervical spinal cord injury without radiographic evidence of trauma (SCIWORET) who were treated non-operatively were analyzed to correlate the magnetic resonance image findings with the initial neurological deficit and the extent of neurological recovery at 2 years. Setting: University tertiary-care teaching hospital in South India. Methods: The neurological status of patients who did not have any radiographic or computerized tomographic abnormality at the time of admission was assessed by ASIA Impairment Scale (AIS) modification of Frankel's grading. The spinal cord abnormality seen in the magnetic resonance imaging was noted. The neurological status at the end of 2 years was recorded. Results: Twenty-seven of the 45 patients (60%) had cord oedema, 8 (17.77%) had cord contusion, 8 (17.77%) patients had a normal cord and 2 (4.44%) patients had cord swelling on the magnetic resonance image. Out of 27 patients who presented with cord oedema, 14 (31.11%) patients recovered from AIS D to AIS E and 6 (13.33%) patients did not recover and remained at AIS D. Seven (15.55%) patients who had a normal cord recovered completely to AIS E. Five (11.11%) patients who had contusion of the cord recovered up to AIS D. Conclusion: The initial neurological status correlates with magnetic resonance imaging findings. Subsequent neurological recovery is dependent on the type of cord damage and initial neurological status. The rate of recovery and the final motor outcome are inversely related to the length of cord involvement.

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Section: Discussioncontrasting

confidence: 98%

“…Previous reports suggest that in the vast majority of instances SCIWORET is associated with incomplete cord injury; [11][12][13] we also noted incomplete cord lesions in 95% of cases with central cord syndrome in half of these patients.…”

Section: Discussionsupporting

confidence: 69%

Cervical spinal cord injuries without radiographic evidence of trauma: a prospective study

et al. 2013

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“…The reported incidence of CSCI without major bone injury ranges from~10 to 16% of all cervical cord injury in North America and India, 6,16 but they are the largest proportion of cervical cord injury in Japan as described by Koyanagi et al 16 The number of CSCI without major bone injury has been increasing as the population ages; data from our institution showed an annual rate of 38.2% in 1990 and 63.2% in 2005. 17 CSCIs without major bone injury have consistently Figure 3 The relationship between the ASIA motor score at discharge and the T1-LCAR.…”

Section: Discussionmentioning

confidence: 53%

“…5 To our knowledge, there have been only few reports on the MRI features of patients with CSCI without major bone injury. 6,7 The most common acute MRI pattern described is no change of signal intensity on T1-weighted images with a blurred high-intensity area on T2-weighted images. In the subacute and chronic stages, a low-intensity area begins to appear on T1-weighted images.…”

Section: Introductionmentioning

confidence: 99%

Subacute T1-low intensity area reflects neurological prognosis for patients with cervical spinal cord injury without major bone injury

et al. 2015

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Study design: A retrospective imaging and clinical study. Objectives: To evaluate the relationship between magnetic resonance imaging (MRI) features and neurological prognosis in patients with traumatic cervical spinal cord injury (CSCI) without major bone injury. Methods: A total of 72 patients with CSCI without major bone injury were treated conservatively in our hospital. MRI was performed for all patients at admission and 1 month following injury. We measured the antero-posterior and cranio-caudal diameter of intramedullary intensity changed area with T1-weighted images at the injured segment. Neurological evaluations were performed using the American Spinal Injury Association (ASIA) motor score and the modified Frankel grade at the time of admission and discharge.Results: There was a significant relationship between the antero-posterior diameter ratio of the T1-weighted low-intensity area on MRI at the subacute stage and the ASIA motor score. The optimal threshold of the T1-weighted low-intensity diameter ratio for predicting the patient's ability to walk with or without assistance at discharge was determined to be 46%. Moreover, 96.8% of the patients with o50% T1-weighted low-intensity area recovered to walk with or without a cane at discharge. Conclusion: The T1-low intensity area may be an important predictive factor for the neurological recovery of CSCI without major bone injury.

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“…10,11 To date, post-operative MRI has not yet been fully studied in relation to the correlation of morphology or signal change of cervical cord and longer term prognosis in patients with SCIWORET. 5,[12][13][14] In our study, we have focused on quantitative analysis of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted MRI pre-and postoperatively. The purpose of the present study was to investigate whether range of signal intensity (RSI), grayscale of signal intensity (GSI), TA of the spinal cord and prevertebral hyperintensities (PVHs) reflect the surgical outcome in patients with SCIWORET.…”

Section: Introductionmentioning

confidence: 99%

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spinal cord injury without radiologic evidence of trauma

Shen

2014

Spinal Cord

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Study design: Prospective study. Objectives: To investigate whether pre-and post-operative changes of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted magnetic resonance imaging (MRI) reflect the surgical outcome in patients with spinal cord injury (SCI) without radiologic evidence of trauma (SCIWORET). Setting: The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. Methods: In 36 consecutive prospective patients, MRI was performed pre-operatively and 3 months post-operatively. The Japanese Orthopaedic Association (JOA) scale and the American Spinal Cord Injury Association (ASIA) motor score (AMS) were used to quantify neurologic status at admission and at least 12-month follow-up. Pre-and post-operative TA, range of signal intensity (RSI), grayscale of signal intensity (GSI) and prevertebral hyperintensities (PVHs) were measured using the image analysis software. Pre-operative status and post-operative recovery were assessed in relation to MRI parameters pre-and post-operatively using univariate and multivariate analysis. Results: Pre-operative JOA and AMS score negatively correlates RSI, GSI and PVH. There was no significant correlation between pre-operative TA and pre-operative JOA and AMS. Recovery rate with JOA negatively correlates pre-operative RSI, post-operative RSI, pre-operative GSI, post-operative GSI and PVH. There was a significant negative correlation between recovery rate with AMS and pre-operative RSI, post-operative GSI and PVH. From these results of multivariate stepwise regression analysis, the predictors of surgical outcomes are pre-operative GSI and pre-operative RSI. Conclusion: Quantitative MRI analysis may provide reliable information for the prediction of the initial neurological status and surgical outcome of patients with SCIWORET.

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Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients

Cited by 108 publications

References 31 publications

Cervical spinal cord injuries without radiographic evidence of trauma: a prospective study

Cervical spinal cord injuries without radiographic evidence of trauma: a prospective study

Subacute T1-low intensity area reflects neurological prognosis for patients with cervical spinal cord injury without major bone injury

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spinal cord injury without radiologic evidence of trauma

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