The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Previous studies that have evaluated the prognostic value of abnormal changes in signals on T2-weighted MRI scans of an injured spinal cord have focused on the longitudinal extent of this signal abnormality in the sagittal plane. Although the transverse extent of injury and the degree of spared spinal cord white matter have been shown to be important for predicting outcomes in preclinical animal models of spinal cord injury (SCI), surprisingly little is known about the prognostic value of altered T2 relaxivity in humans in the axial plane.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors undertook a retrospective chart review of 60 patients who met the inclusion criteria of this study and presented to the authors’ Level I trauma center with an acute blunt traumatic cervical SCI. Within 48 hours of admission, all patients underwent MRI examination, which included axial and sagittal T2 images. Neurological symptoms, evaluated with the grades according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS), at the time of admission and at hospital discharge were correlated with MRI findings. Five distinct patterns of intramedullary spinal cord T2 signal abnormality were defined in the axial plane at the injury epicenter. These patterns were assigned ordinal values ranging from 0 to 4, referred to as the Brain and Spinal Injury Center (BASIC) scores, which encompassed the spectrum of SCI severity.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The BASIC score strongly correlated with neurological symptoms at the time of both hospital admission and discharge. It also distinguished patients initially presenting with complete injury who improved by at least one AIS grade by the time of discharge from those whose injury did not improve. The authors’ proposed score was rapid to apply and showed excellent interrater reliability.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The authors describe a novel 5-point ordinal MRI score for classifying acute SCIs on the basis of axial T2-weighted imaging. The proposed BASIC score stratifies the SCIs according to the extent of transverse T2 signal abnormality during the acute phase of the injury. The new score improves on current MRI-based prognostic descriptions for SCI by reflecting functionally and anatomically significant patterns of intramedullary T2 signal abnormality in the axial plane.</jats:p></jats:sec>

Update on critical care for acute spinal cord injury in the setting of polytrauma

“…This scale showed strong correlations with AIS grade both at admission and at discharge, with high interrater reliability (kappa 0.81-0.83). 69 The stratification of SCI by using the extent of transverse T2 pathology shows promise in enhancing injury classification as well as outcome prediction.…”

MRI Atlas-Based Measurement of Spinal Cord Injury Predicts Outcome in Acute Flaccid Myelitis

“…The %GM T2 signal hyperintensity on a single axial section at the most affected level of the injury center (referred to as "lesion center") provided the strongest correlation with clinical measures of motor impairment and recovery. The value of assessing the transverse extent of T2 abnormality on a single axial section at the injury center has been similarly demonstrated in the setting of acute traumatic SC injury and compressive myelopathy, 18,27 suggesting that the transverse extent of injury in the SC on MR imaging carries significant diagnostic and prognostic information in a variety of pathologies. This result is significant because it allows for a more focused, rapid evaluation of the MR imaging findings centered at the injury center.…”

“…We hypothesized that the degree of GM and WM signal abnormality in these patients would both correlate with severity of initial symptoms and symptoms at follow-up after hospitalization. Although several studies have investigated the association between GM and WM signal abnormality on MR imaging and disease severity, [13][14][15][16][17][18] to date, this is first study using this analysis method to register SCs with abnormal signal to an unbiased average anatomic template; quantify proportions of GM (%GM), WM (%WM), and CSA (%CSA) occupied by lesion in the probabilistic template; and correlate data with clinical outcomes.…”

A prospective serial MRI study following acute traumatic cervical spinal cord injury

“…Furthermore, it will be important to identify which time point for an MRI scan after SCI has the best prognostic value for neurological recovery. The recently introduced BASIC classification for SCI strongly correlates with potential neurological recovery [22]. Including the BASIC classification in future serial MRI studies is an important step to determine the time point at which an MRI has the best prognostic value [22].…”