Sequential MR studies of cervical cord injury: correlation with neurological damage and clinical outcome

Abstract

In patients with acute traumatic cervical spinal cord injury, it is di cult to make a precise diagnosis of the main site of the injury, the severity of cord damage, and the prognosis of neurological complications Objective: To determine which images provide the most useful information and the best time to perform prognostic MRI. Design: The severity of neurological complications was assessed using the ASIA impairment scale. MRI was ®rst performed within 48 h of injury, and was subsequently performed after 2 ± 3 weeks, 3 months, 6 months, and 1 year. Setting: Inpatient SCI medicine unit. Subjects: Seventy-®ve patients with acute traumatic cervical spinal cord injury (9 women and 66 men) aged from 19 ± 89 years (mean: 54.7 years). Results: Four characteristic patterns of signal changes were observed on MRI. These patterns correlated well with the severity of spinal cord damage and the clinical outcome. Conclusion: T2-weighted images provided the most useful information, and the best times for prognostic imaging were at the time of injury and 2 ± 3 weeks later.

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy

“…Generally, intramedullary Gd-DTPA enhanced MRI reveal intramedullary lesions, including intramedullary tumors, multiple sclerosis, sarcoidosis, myelitis, and spinal cord infarction [2,14,19]. Recently, intramedullary Gd-DTPA enhanced MRI findings were known to appear in spinal cord injuries [14,19]. Shimada et al [14] observed a contrast enhancement of the injured cords of patients who had experienced a spinal cord injury.…”

“…Gd-DTPA enhancement can indicate a disruption to the parenchyma of the spinal cord and a disturbance in the BCB of the spinal cord [2]. Generally, intramedullary Gd-DTPA enhanced MRI reveal intramedullary lesions, including intramedullary tumors, multiple sclerosis, sarcoidosis, myelitis, and spinal cord infarction [2,14,19]. Recently, intramedullary Gd-DTPA enhanced MRI findings were known to appear in spinal cord injuries [14,19].…”

“…One iliac bone and Atlantis plate (Medtronic Sofamor-Danek, Memphis, TN) were used in 29 cases, while a Cervios cage (Synthes, Oberdorf, Germany) and Atlantis plate were used in 16 cases. Twenty-nine patients underwent a two level ACDF, as these patients were diagnosed with a two level CCM at C3-4-5 (7), C4-5-6 (8), or C5-6-7 (14). For this ACDF procedure, two autologous iliac bones and an Atlantis plate were used in each of the cases.…”

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

“…9,[12][13][14] Edema is seen in T2 MR imaging sequences as hyperintensity of the signal within the cord, whereas a low intensity area on T2-weighted images in the acute stage is thought to indicate intramedullary hemorrhage, attributed to deoxyhemoglobin. 15,16 In addition, because hemorrhage is almost always concurrent with edema, it is common to measure signal hyperintensity in T2-weighted images to determine the length of the lesion.…”

Patient and caregiver knowledge of severity of injury among youth with spinal cord injury

“…The current form of the exam which provides standardization for motor and sensory testing is referred to as the International Standards for Neurological Classification in Spinal Cord Injury (ISCSCI). 4 The results derived from the ISCSCI exam can help with injury prognosis, [5][6][7] help determine the eligibility for clinical trials 8,9 and assist in ongoing evaluation of neurological symptoms. [10][11][12] Despite the clinical usefulness of the ISCSCI, it may be an unreliable exam in young children in determining whether an injury is complete or incomplete.…”