Prognostic value of changes in spinal cord signal intensity on magnetic resonance imaging in patients with cervical compressive myelopathy

Uchida, Kenzo; Nakajima, Hideaki; Takeura, Naoto; Yayama, Takafumi; Guerrero, Alexander Rodríguez; Yoshida, Akira; Sakamoto, Takumi; Honjoh, Kazuya; Baba, H.

doi:10.1016/j.spinee.2013.09.038

Cited by 70 publications

(61 citation statements)

References 24 publications

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“…Ramanauskas reported that in the early and intermediate stages, the spinal cord showed high SI on T2WI, while at a later stage, the spinal cord showed low SI on T1WI and high SI on T2WI. [32] Some studies [11,13] reported that decreased SI on T1WI is a poor prognostic factor. The prevalence of T1-weighted changes ranges 2.3% to 26.9% among patients with cervical myelopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Uchida et al [13] reported that the SIR on T1WI, but not SIR on T2WI, was correlated with clinical outcome in cervical myleopathy. We did not find a correlation between the SIR on T1WI and postoperative neurological outcome in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Since that report, a few studies [10–13] have focused on the quantitative assessment of SI changes and their prognostic significance. Most of these studies assessed the SI of the spinal cord based on T2WI alone, but not on T1WI and gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) contrast-enhanced MRI.…”

Section: Introductionmentioning

confidence: 99%

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Signal intensity ratio on magnetic resonance imaging as a prognostic factor in patients with cervical compressive myelopathy

Kim

Ha²,

Shin

et al. 2016

Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Signal intensity ratio on magnetic resonance imaging as a prognostic factor in patients with cervical compressive myelopathy

Kim

Ha²,

Shin

et al. 2016

Medicine

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“…5,6 The presence of such lesions has been associated with slowed recovery across a number of model systems and in humans. 2,7,8 More recently, spinal cord lesion volume as measured by MRI has been used to quantitatively characterize SCI following clinical interventions. 9 Canine intervertebral disk herniation (IVDH) is a common, naturally occurring SCI that is seen in pet dogs.…”

Section: Introductionmentioning

confidence: 99%

Quantitative magnetic resonance imaging in a naturally occurring canine model of spinal cord injury

Griffin

Davis

et al. 2015

Spinal Cord

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Study design: Retrospective cohort study. Objectives: To analyze magnetic resonance imaging (MRI) evaluator agreement in dogs with spinal cord injury (SCI) caused by intervertebral disk herniation (IVDH) using semiautomated and manual lesion segmentation and to analyze the associations between MRI and functional outcome. Setting: United States of America. Methods: T2-weighted MRIs from dogs with SCI resulting from thoracolumbar IVDH were identified from a database. Evaluators categorized MRIs on the basis of the presence or absence of a T2-hyperintense spinal cord lesion in axial and sagittal images. A semiautomated segmentation algorithm was developed and used to estimate the lesion volume. Agreement between evaluators and between semiautomated and manual segmentation was analyzed. The relationships of qualitative and quantitative MRIs with behavioral functional outcome were analyzed. Results: Axial images more commonly depicted lesions compared with sagittal images. Lesions in axial images had more consistent associations with functional outcome compared with sagittal images. There was imperfect qualitative agreement, and lesion volume estimation was imprecise. However, there was improved precision using semiautomated segmentation compared with manual segmentation. Conclusion: Lesion volume estimation in dogs with naturally occurring SCI caused by IVDH is challenging, and axial images have important advantages compared with sagittal images. The semiautomated segmentation algorithm described herein shows promise but may require further refinement. INTRODUCTIONSpinal cord injury (SCI) is a devastating disease process that results in disability, loss of quality of life and cost to the health-care system. Currently, there are no therapies that robustly improve functional outcomes. 1 Magnetic resonance imaging (MRI) has been used in humans to diagnose SCI for three decades and has been proposed as a viable in vivo biomarker. 2-4 High T2 signal intensity within the spinal cord following injury is correlated with identifiable edema, necrosis, cellular infiltrates and hemorrhage. 5,6 The presence of such lesions has been associated with slowed recovery across a number of model systems and in humans. 2,7,8 More recently, spinal cord lesion volume as measured by MRI has been used to quantitatively characterize SCI following clinical interventions. 9 Canine intervertebral disk herniation (IVDH) is a common, naturally occurring SCI that is seen in pet dogs. 10,11 Canine IVDH shares many features with human SCI including lesion histopathology, presence of compressive/contusive facets of injury and use of surgical/ rehabilitative treatment modalities. 10,11 As is the case in humans, data from dogs with IVDH suggest that T2-hyperintense lesions within the spinal cord are correlated with behaviorally severe injuries and poorer long-term motor recovery. 11

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“…Both are associated with poorer neurological outcome even after surgical decompression. (10,11) Special T2* gradient-recalled echo images can show the hypointense ossifi ed lesions more prominently, but must be interpreted with caution, as 'blooming' artefact on this sequence can overestimate the extent of spinal canal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Clinics in diagnostic imaging (161)

Tan¹,

Wong²

2015

smedj

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A 53-year-old man presented with acute weakness of all four limbs (more on the right side) after an assault, during which he fell on his right side. He reported no urinary problems, but had not had any bowel movement for the past fi ve days.On examination, the patient had bilateral hypoaesthesia from the C5 to T1 level. Muscle strength in both upper limbs was decreased, with the right side affected more than the left. Muscle strength was also markedly reduced (1/5) in the right lower limb but full (5/5) in the left lower limb. Refl exes were graded 3+ in both upper limbs and the right lower limb, and 2+ in the left lower limb. Babinski refl ex was negative. Abdominal examination was signifi cant for a palpable, distended bladder and urinary catheterisation yielded 1,100 mL of urine. Sphincter tone was normal.A cervical spine radiograph ( Fig. 1) was initially obtained, followed by magnetic resonance (MR) imaging (Fig. 2) and computed tomography (CT) (Fig 3). What do the images show? What is the status of the cervical spinal cord?

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Prognostic value of changes in spinal cord signal intensity on magnetic resonance imaging in patients with cervical compressive myelopathy

Cited by 70 publications

References 24 publications

Signal intensity ratio on magnetic resonance imaging as a prognostic factor in patients with cervical compressive myelopathy

Signal intensity ratio on magnetic resonance imaging as a prognostic factor in patients with cervical compressive myelopathy

Quantitative magnetic resonance imaging in a naturally occurring canine model of spinal cord injury

Clinics in diagnostic imaging (161)

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