MRI in the acute phase of spinal cord traumatic lesions: Relationship between MRI findings and neurological outcome.
OBJECTIVE
To evaluate the role of emergency MRI in the diagnosis of acute spinal injuries, and to correlate the MRI pattern with the neurological outcome.


METHODS
Thirty-eight patients with MRI-proven spinal cord injury were classified according to the Frankel classification. MRI was always performed within 8 hours from trauma. Frankel classification divides spinal cord injuries into 5 classes of decreasing severity based on the presence of motor and/or sensory function loss. On the basis of the MRI findings the patients were classified in 3 groups: group 1 (intramedullary haematoma), group 2 (multi-metamer oedema), group 3 (single-metamer oedema). All patients underwent neurosurgery and were clinically evaluated until the stabilization of neurological recovery. Mean follow-up time was 12 months. The MR images were retrospectively evaluated and correlated to the neurological outcome.


RESULTS
Twenty-eight patients showed complete motor loss (Frankel classes A and B); of these 28 patients 12 (42.8%) had MRI evidence of intramedullary haematoma, 12 (42.8%) had multi-metamer oedema and 4 (14.4%) had single-metamer oedema. Of the 10 patients with incomplete motor loss, none had MRI evidence of haemorrhage, 4 (40%) showed multi-metamer oedema and 6 (60%) showed single-metamer oedema. Follow-up clinical assessment revealed that 14/38 patients (36,8%) had clinical improvement and 2/38 cases (5%) had a complete motor recovery, as demonstrated by the move to a higher Frankel class.


CONCLUSIONS
Our results, consistent with previous reports, confirm a strong correlation between the MRI appearance of traumatic spinal cord injuries in acute phase and long-term recovery of motor and sensory function: patients with initial haemorrhage had a poor prognosis, whereas those with spinal cord oedema had a good clinical outcome, as demonstrated by the passage to a higher Frankel class. MRI is particularly important in the initial evaluation of unconscious patients who cannot undergo a motor and sensory neurological evaluation, and to define the prognosis, which will influence the correct therapeutic choice.
Andreoli
Chiara
C
Servizio di Radiologia, Dipartimento di Emergenza ed Accettazione, Azienda Policlinico Umberto I, Roma. chiaraand@tiscali.it
Colaiacomo
Maria Chiara
MC
Rojas Beccaglia
Mario
M
Di Biasi
Claudio
C
Casciani
Emanuele
E
Gualdi
Gianfranco
G
D000208:Acute Disease; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology; D004487:Edema; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D013119:Spinal Cord Injuries / Q000145:classification / Q000175:diagnosis*