Magnetic resonance imaging and neurological recovery in acute spinal cord injury: observations from the National Acute Spinal Cord Injury Study 3

Abstract

Study design: Data are from a multicenter, randomized, double blind clinical trial of acute spinal cord injury. Objectives: To evaluate the prognostic value of magnetic resonance imaging (MRI) for randomized patients in the National Acute Spinal Cord Injury Study 3 (NASCIS). Setting: Sixteen spinal cord injury centers throughout the United States and Canada. Methods: Of 499 patients randomized in NASCIS 3 between December 1991 and September 1995, MRI was electively done on 191 patients within 72 h of injury. Indications of hemorrhage, edema, and contusion were recorded by standard protocol. Neurological impairment as determined by motor function, response to pin prick and light touch was assessed at admission to the participating center and 6 weeks after injury. Change in neurological function was obtained by subtracting the score of each neurological parameter at admission from that measured at 6 weeks. Spinal cord surgery performed within the 3 days after injury was noted. Data were analyzed by: chi square, analysis of variance, multiple logistic regression and linear regression models. Results: Patients with hemorrhage were much more likely to have a complete injury (OR=2.88, 95 Cl 1.32, 6.23); however this association was much reduced when the initial neurological examination was taken into account (AOR=1.43, 95% Cl 0.55, 3.73) and was no longer a signi®cant predictor of injury. MRI evidence of cord edema was the strongest predictor of reduced improvement in motor function (73.34 points, P=0.06) and light touch sensation (73.41 points, P=0.05) at 6 weeks. Conclusions: Cord hemorrhage, contusion, and edema on MRI were not associated with diagnosis of a complete cord injury after neurological assessment from the initial clinical examination was taken into account. Prediction of a worse 6 week neurological status was weakly associated with the presence of edema diagnosed by MRI. As MRI technology improves, these diagnostic and predictive capabilities need to be re-assessed.

Anti-edema effect of melatonin on spinal cord injury in rats

“…Secondary damage after SCI includes edema, altered blood flow, and changes in microvascular permeability 33,34 . Traumatic injury to the spinal cord is often associated with edema that is predominant in the gray matter 19,35 . This progressive, active spread of damage begins within minutes after initial injury and continues for weeks 36 .…”

Spinal Cord Injury after Blunt Cervical Spine Trauma: Correlation of Soft-Tissue Damage and Extension of Lesion

“…Excessive edema, changes in T2-weighted images, greater degree of cord compression, and hemorrhage have been related to worse neurologic outcomes. 9,[35][36][37][38] Gain in motor strength at follow-up has been seen to correlate with a decrease in T2-weighted hyperintensity in serial MR imaging studies. 39 Some authors have described a close correlation between level of injury and severity of SCI.…”

Diffusion Tensor Imaging at 3 Hours after Traumatic Spinal Cord Injury Predicts Long-Term Locomotor Recovery

“…However, it provides no direct measurement of axonal integrity (Miyanji et al, 2007;Shepard and Bracken, 1999). Diffusion tensor imaging (DTI) provides detailed micro-structural information about myelinated axons and the associated pathophysiological changes with quantifiable parameters (Pierpaoli and Basser, 1996).…”