Abstract:
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Purpose: Determining prognosis after traumatic spinal cord injury is difficult, especially in the motor impairment phase of spinal shock. We used emergency MRI to determine the prognosis of these patients.
Methods and Materials: Thirty-two patients with severe cervical cord injury who underwent emergency MRI within 24 hours after being injured (mean, 6.0 hours) were entered into this study. All of them presented with complete motor impairment below the injured neural level, although they had good levels of consiousness at the initial physical examination (mean, 2.5 hours). MRI was performed with a 1.5T superconducting unit (Somatom H15; Siemens, Germany), employing spin-echo sequences with a surface coil. The antero-posterior diameter of the intremedullary low-intensity (LI) area detected in a T2-weighted image, which was suggestive of hematoma, was measured using computer software (NIH Image). Patients with severe canalstenosis were excluded. The relationship between the clinical outcome and the size of the LI area was examined. Six patients were followed with MRI every 6 months for two years.
Results: Fourteen patients were eliminated because of severe canal stenosis. Among the remaining 18 patients, 10 patients who had a large LI area (>3mm) on initial MRI were completely motor impaired (FrankelA or B)twelve months after the injury. Eight patients who had a small LI area (<3mm) showed motor recovery, at least in the lower extremities (FrankelC or D). Follow-up MRI showed that the size of the hematoma did not change after the initial study.
Conclusion: We suspect that, in the acute phase T2 study, cord edema extends rapidly after injury and that its intensity strengthens, masking the low signal of the hematoma. Thus, a precise image of a hematoma can be obtained only by emergency MRI, and should reflect the severity of the irreversible damege. Measurement of the antero-posterior diameter of the low intensity areas on T2-weighted sagittal images within 24 hours after cervical cord injury is useful for forecasting functional outcomes. If the antero-posterior diameter is smaller than 3mm, motor function in the lower extrimities should improve.
Questions about this event email: geru-6@wb3.so-net.ne.jp
Mitsuhashi MD, S,
Use of Emergency MRI to Predict Motor Recovery after Traumatic Cervical Cord Injury. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3103267.html
