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Acute Cervical Traumatic Spinal Cord Injury: MR Imaging Findings Correlated with Neurologic Outcome—Prospective Study with 100 Consecutive Patients¹

¹ From the Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, 399 Bathurst St, West Wing, 4th Floor, Room 449, Toronto, Ontario, Canada M5T 2S8 (F.M., J.C.F., M.G.F.); Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (F.M., J.C.F., M.G.F.); Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Md (B.A.); and Kansas University Neurological Surgery, Kansas City, Mo (P.M.A.). Received April 4, 2006; revision requested May 31; revision received June 30; accepted August 2; final version accepted October 4. M.G.F., P.M.A., B.A. supported by funds from an unrestricted grant to the Spine Trauma Study Group, Minneapolis, Minn. J.C.F. supported by the Lawson Fellow-Neurology from The Toronto General & Western Hospital Foundation. M.G.F. supported by the Krembil Chair in Neural Repair and Regeneration. Address correspondence to M.G.F. (e-mail: michael.fehlings{at}uhn.on.ca).

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 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.

© RSNA, 2007

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