Acute cervical traumatic spinal cord injury: MR Imaging findings correlated with neurologic outcome - Prospective study with 100 consecutive patients

Purpose: To prospectively evaluate whether quantitative and qualitative magnetic resonance ( MR) imaging assessments after spinal cord injury ( SCI) correlate with patient neurologic status and are predictive of outcome at long-term follow-up. Materials and Methods: The study included 100 patients ( 79 male, 21 female; mean age, 45 years; age range, 17-96 years) with traumatic cervical SCI. Ethics committee approval and informed consent were obtained. The American Spinal Injury Association ( ASIA) motor score was used as the outcome measure at admission and follow-up. The ASIA impairment scale was used to classify patients according to injury severity. Three quantitative ( maximum spinal cord compression [ MSCC], maximum canal compromise [ MCC], and lesion length) and six qualitative ( intramedullary hemorrhage, edema, cord swelling, soft-tissue injury [ STI], canal stenosis, and disk herniation) imaging parameters were studied. Data were analyzed by using the Fisher exact test, the Mantel-Haenszel chi(2) test, analysis of variance, analysis of covariance, and stepwise multivariable linear regression. Results: Patients with complete motor and sensory SCIs had more substantial MCC ( P = .005), MSCC ( P = .002), and lesion length ( P = .005) than did patients with incomplete SCIs and those with no SCIs. Patients with complete SCIs also had higher frequencies of hemorrhage ( P < .001), edema ( P < .001), cord swelling ( P = .001), stenosis ( P = .01), and STI ( P = .001). MCC ( P = .012), MSCC ( P = .014), and cord swelling ( P < .001) correlated with baseline ASIA motor scores. MSCC ( P = .028), hemorrhage ( P < .001), and cord swelling ( P = .029) were predictive of the neurologic outcome at follow-up. Hemorrhage ( P < .001) and cord swelling ( P = .002) correlated significantly with follow-up ASIA score after controlling for the baseline neurologic assessment. Conclusion: MSCC, spinal cord hemorrhage, and cord swelling are associated with a poor prognosis for neurologic recovery. Extent of MSCC is more reliable than presence of canal stenosis for predicting the neurologic outcome after SCI. (c) RSNA, 2007.