title: Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome--prospective study with 100 consecutive patients.
abstract: 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.
authors: Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, 399 Bathurst St, West Wing, 4th Floor, Room 449, Toronto, Ontario, Canada.
authors: Firoz
authors: F
authors: Miyanji
authors: Julio C
authors: JC
authors: Furlan
authors: Bizhan
authors: B
authors: Aarabi
authors: Paul M
authors: PM
authors: Arnold
authors: Michael G
authors: MG
authors: Fehlings
mesh_terms: 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