Prediction of neurological recovery in spontaneous spinal epidural hematoma using apparent diffusion coefficient values

Abstract

Objective: Magnetic resonance imaging (MRI) is useful in diagnosing spontaneous spinal epidural hematoma (SSEH). The purpose of the present study is to determine whether apparent diffusion coefficient (ADC) values could determine severity of spinal cord damage and predict functional recovery in SSEH. Methods: The study involved four consecutive patients with SSEH (two men and two women: aged 21-76 years). Using axial slices, ADC values were determined in four separate regions of the spinal cord. These areas were classified into the following three groups based on findings in T2-weighted images: normal T2 intensity; persistent T2 abnormality; and temporary T2 abnormality. ADC values among different groups were compared. The relationship between preoperative ADC values and neurological grades were also evaluated. Results: ADC values in normal T2 areas were 0.89 ± 0.10 Â 10 À3 mm 2 s À1 , whereas those for the persistent T2 abnormality group were significantly lower (0.63 ± 0.14 Â 10 À3 ). In a patient who was Frankel A on admission and in the follow-up, the ADC value was as low as 0.41 Â 10 À3 . Functional recovery was also limited in the spinal cord segments with lower ADC values. In the temporary T2 abnormality group, ADC values were significantly higher (1.05±0.10 Â 10 À3 ). Conclusions:In SSEH, if MRI demonstrated T2-hyperintensity with lower ADC values, patients may suffer from irreversible spinal cord damages. ADC values of the spinal cord can be added as a new factor that reliably indicated the severity of spinal cord damage and predicted functional recovery.

A Diagnostic Biomarker for Cervical Myelopathy Based on Dynamic MRI

“…ADC, AD, RD, and FA values were determined using Siemens syngo through Neuro-3D software (Siemens Healthcare, Erlangen, Germany). Fiber tracking uses mathematical models to reveal the main direction of the fibers according to a voxel-by-voxel–based analysis using the directional information of the largest eigenvector of the diffusion tensor 10 . A deterministic fixed-step tracking algorithm, which uses the directional information described by the diffusion tensor, was used.…”

“…It uses a Gaussian model for DTI, but one which does not imply that there is only one fiber population per voxel. The model spreads several seeds per voxel and takes the neighboring DTI voxel information into account by interpolation 10 . For stopping criterion the following parameters were used: seeding threshold FA, 0.10; step size, 0.5 mm; stopping criteria for tracking FA, 0.10; and deflection angle, 60 o .…”

“…Fiber tracking uses mathematical models to reveal the main direction of the fibers according to a voxel-by-voxel-based analysis using the directional information of the largest eigenvector of the diffusion tensor. 10 A deterministic fixed-step tracking algorithm, which uses the directional information described by the diffusion tensor, was used. It uses a Gaussian model for DTI, but one which does not imply that there is only one fiber population voxel.…”

Spontaneous Spinal Epidural Haematomas

“…However, this condition can result in death, with two children having been reported to have died following a SSEH. One child died from respiratory failure after operative intervention and the other without a cause for death being defined, but with evidence of progressive neurological dysfunction after surgical decompression [3,4].…”

“…Spinal epidural haematomas (SEH) occur from extra-dural bleeding, most commonly after trauma, epidural anaesthesia or operative intervention [1,2]. These haematomas are rare but carry a significant risk of spinal cord or nerve root compression potentially resulting in permanent neurological dysfunction and death [3,4].…”