Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spinal cord injury without radiologic evidence of trauma

Abstract

Study design: Prospective study. Objectives: To investigate whether pre-and post-operative changes of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted magnetic resonance imaging (MRI) reflect the surgical outcome in patients with spinal cord injury (SCI) without radiologic evidence of trauma (SCIWORET). Setting: The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. Methods: In 36 consecutive prospective patients, MRI was performed pre-operatively and 3 months post-operatively. The Japanese Orthopaedic Association (JOA) scale and the American Spinal Cord Injury Association (ASIA) motor score (AMS) were used to quantify neurologic status at admission and at least 12-month follow-up. Pre-and post-operative TA, range of signal intensity (RSI), grayscale of signal intensity (GSI) and prevertebral hyperintensities (PVHs) were measured using the image analysis software. Pre-operative status and post-operative recovery were assessed in relation to MRI parameters pre-and post-operatively using univariate and multivariate analysis. Results: Pre-operative JOA and AMS score negatively correlates RSI, GSI and PVH. There was no significant correlation between pre-operative TA and pre-operative JOA and AMS. Recovery rate with JOA negatively correlates pre-operative RSI, post-operative RSI, pre-operative GSI, post-operative GSI and PVH. There was a significant negative correlation between recovery rate with AMS and pre-operative RSI, post-operative GSI and PVH. From these results of multivariate stepwise regression analysis, the predictors of surgical outcomes are pre-operative GSI and pre-operative RSI. Conclusion: Quantitative MRI analysis may provide reliable information for the prediction of the initial neurological status and surgical outcome of patients with SCIWORET.

Pediatric Spinal Cord Injury without Radiographic Abnormality

“…As far as we know, this is the first retrospective study of pediatric SCIWORA in mainland China, although there have been few retrospective studies of adult SCIWORA here over the past years. [30][31][32][33][34] Furthermore, this is one of only two retrospective studies of pediatric SCIWORA with more than 100 patients at a single hospital; the other one was conducted at Children's Hospital of Pittsburgh from 1965 through 1999. 21 Demographic differences were observed between the patients in this study and the previous studies.…”

Spinal cord injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome

“…Although a correlation between neurological outcome and MRI pattern has been described previously, 4,5,[11][12][13][14][15][16][17][18] this finding could not be confirmed by others. 2 The present study reports the existence of a relation between imaging type and neurological outcome in adult patients with SCIWORA.…”

The role of diffusion tensor imaging in the diagnosis, prognosis, and assessment of recovery and treatment of spinal cord injury: a systematic review

“…A limitation of the scale is the high variance of T2 signal in images obtained > 24 hours after injury. 36,56,60 Nonetheless, the BASIC system would be easier to implement because T2 sequences are obtained routinely for patients with SCI. 60…”