Diagnostic and prognostic role of magnetic resonance imaging in spinal trauma, and correlation with clinical profile

Abstract

Background: Trauma is a common and devastating insult to the spine and spinal cord with important long-term sequelae for the individual. Diagnostic imaging, particularly Magnetic Resonance Imaging (MRI), plays a crucial role in evaluating and detecting spinal trauma. MRI is not only a diagnostic tool in spinal trauma but also a prognostic predictor. It is possible to predict the neurological outcome of the patients with different cord abnormalities. The objective of this study is to enumerate the cord findings in MRI in patients with spinal trauma and to correlate the findings with clinical profile and neurological outcome of the patients.Methods: A total of 50 cases of spinal trauma over a period of 1 year were included in the study. MRI of spine performed in patients with spinal trauma to see the cord findings. Detailed motor and sensory examination of the patient on admission and discharge was done and graded according to American Spinal Injury Association Scale (ASIA). Chi square test of significance (p<0.005) was used to assess the association between MR findings and clinical outcome.Results: In the study we observed that patients with cord haemorrhage and large cord oedema had initial high grade AIS and less chance of recovery with vice versa. Patients with presence of focus of haemorrhage had more severe grade of initial ASIA than those without haemorrhage with significantly more chances of retaining complete injury at follow up. Patients with edema less than 3cm improved on follow up examination.Conclusions: MRI is an excellent modality of imaging in the diagnosis of cord abnormalities in spinal trauma. The cord findings correlate with the neurological deficit of the patient on admission and discharge.

Added Value of Three-Plane Multiecho Fast Field Echo MRI Sequence in the Evaluation of Acute Spinal Trauma Using Sensitivity: A Prospective Study

“…Application of three-plane mFFE sequences can better identify the cord hemorrhage, various vertebral body and posterior element fractures which may in some situations obviate the need for a CT scan [13]. In our study sample of 48 patients, the majority of patients being males (75%).…”

“…MRI is more sensitive in detecting occult bony injuries in vertebral body than posterior vertebral element because a lesser amount of cancellous bone in posterior vertebral element [12]. GRE sequence able to identify cord hemorrhage as dark signal intensity (blooming), extra-medullary hemorrhage and even vertebral body and posterior elements fractures [13]. The spinal cord hemorrhage appears as low signal intensity on T2WI with surrounding T2WI hyperintense edema.…”

“…The spinal cord hemorrhage appears as low signal intensity on T2WI with surrounding T2WI hyperintense edema. Three-plane mFFE sequence is the best for determining the location, size, extent of spinal cord hemorrhage which may be underestimated on conventional spin-echo MRI sequences [13].…”

Introductory Chapter: Magnetic Resonance Imaging in Internal Medicine

“…MRI is not only a diagnostic tool in spinal trauma, but also a prognostic predictor. It is possible to predict the neurological outcome of the patients with different cord abnormalities [8].…”