Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome--prospective study with 100 consecutive patients.
OBJECTIVE
To prospectively evaluate whether quantitative and qualitative magnetic resonance (MR) imaging assessments after spinal cord injury (SCI) correlate with patient neurologic status and are predictive of outcome at long-term follow-up.


METHODS
The study included 100 patients (79 male, 21 female; mean age, 45 years; age range, 17-96 years) with traumatic cervical SCI. Ethics committee approval and informed consent were obtained. The American Spinal Injury Association (ASIA) motor score was used as the outcome measure at admission and follow-up. The ASIA impairment scale was used to classify patients according to injury severity. Three quantitative (maximum spinal cord compression [MSCC], maximum canal compromise [MCC], and lesion length) and six qualitative (intramedullary hemorrhage, edema, cord swelling, soft-tissue injury [STI], canal stenosis, and disk herniation) imaging parameters were studied. Data were analyzed by using the Fisher exact test, the Mantel-Haenszel chi(2) test, analysis of variance, analysis of covariance, and stepwise multivariable linear regression.


RESULTS
Patients with complete motor and sensory SCIs had more substantial MCC (P=.005), MSCC (P=.002), and lesion length (P=.005) than did patients with incomplete SCIs and those with no SCIs. Patients with complete SCIs also had higher frequencies of hemorrhage (P<.001), edema (P<.001), cord swelling (P=.001), stenosis (P=.01), and STI (P=.001). MCC (P=.012), MSCC (P=.014), and cord swelling (P<.001) correlated with baseline ASIA motor scores. MSCC (P=.028), hemorrhage (P<.001), and cord swelling (P=.029) were predictive of the neurologic outcome at follow-up. Hemorrhage (P<.001) and cord swelling (P=.002) correlated significantly with follow-up ASIA score after controlling for the baseline neurologic assessment.


CONCLUSIONS
MSCC, spinal cord hemorrhage, and cord swelling are associated with a poor prognosis for neurologic recovery. Extent of MSCC is more reliable than presence of canal stenosis for predicting the neurologic outcome after SCI.
Miyanji
Firoz
F
Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, 399 Bathurst St, West Wing, 4th Floor, Room 449, Toronto, Ontario, Canada.
Furlan
Julio C
JC
Aarabi
Bizhan
B
Arnold
Paul M
PM
Fehlings
Michael G
MG
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis*; D013223:Statistics as Topic