Abstract:
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Purpose: To determine if the routine administration of methylprednisolone immediately following spinal cord injury has an effect on lesion severity demonstrated by MR imaging.
Methods and Materials: Patients with cervical spinal injury treated with the recommended dose of methylprednisolone (bolus 30 mg/kg + 5.4 mg/kg over 23 hours) initiated within 8 hours of injury were compared to patients that did not receive any steroids. The neurologic degree of impairment (ASIA grade) and level of neurologic injury at time of admission was noted and used to group patients into classes sustaining similar degrees of functional injury. All patients (n=187) underwent MR imaging on the same 1.5 Tesla unit using a similar imaging protocol. The length of spinal cord edema and intramedullary hemorrhage was measured on sagittal T2-weighted and gradient echo MR images. Comparisons of lesion severity were then made between untreated and treated subjects.
Results: 37 of 103 patients with motor complete injuries (ASIA grade A or B) and 40 of 84 patients with motor incomplete injuries (ASIA grade C or D) received the initiation of steroid therapy within 8 hours of injury. In patients with motor complete injury, there were significantly fewer patients exhibiting spinal cord hemorrhage in the treated group compared to the untreated group (54% vs. 85%, p<0.0007). The mean length (arbitrary units) of the surrounding edema (total lesion length) was also significantly different in treated vs. untreated patients (8.6 vs. 10.4, p=0.031). The mean length of intramedullary hemorrhage (when present) was 1.4 vs. 2.7, a result that fell short of statistical significance (p=0.078). In the motor incomplete group, the number of patients exhibiting spinal cord hemorrhage was substantially less than in the motor complete group, as expected in patients sustaining less severe injury. Here, no significant difference was detected in patients exhibiting spinal cord hemorrhage in treated vs. untreated patients (18% vs. 23%, p=0.55), nor was there a difference in mean length of intramedullary hemorrhage (1.0 in both groups). However, patients in the motor incomplete group treated with steroids did exhibit a trend towards decreased length of edema when compared to untreated patients (4.0 vs. 5.4, p=0.065).
Conclusion: Methylprednisolone therapy may have an effect on the appearance of spinal cord injury on MR imaging.
Questions about this event email: bleypo@yahoo.com
Leypold MD, PhD, B,
Does Methylprednisolone Administration Affect MR Lesion Severity in Spinal Cord Injury?. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3105631.html
