MRI for spinal cord injuries -
In addition to neurological signs e. altered sensation, limb weakness, autonomic dysfunction, and sphincter disruption there is usually pain due to related injury to the musculoskeletal components of the spine. Injuries can be complete or incomplete at a specified level.
The most common system is the American Spinal Injury Association ASIA Impairment Scale 2. These have no real role in traumatic cord injury in patients with significant trauma as they have limited sensitivity for detecting spinal cord trauma and bony injuries associated with it.
This is best for assessing the associated bony injuries which may need concomitant treatment consideration but does not assess the cord itself. Apart from routine axial and sagittal T1 and T2 imaging additional sequences should be considered depending on the clinical concern.
gradient echo , SWI are more sensitive to hemorrhage, while STIR sequences are more sensitive to associated ligamentous injury. Articles: RANZCR key conditions assessment Spinal cord injury Thoracic spine fracture-dislocation Brain and Spinal Cord Injury Center score Discoligamentous injury Occipital condyle fracture Burst fracture Spinal cord transection Spinal cord Cases: Flexion teardrop fracture with cord injury Cervical spine fracture - ankylosing spondylitis Traumatic spinal cord injury Vertebral burst fracture Post traumatic myelopathy with prevertebral haematoma Traumatic spinal cord injury Traumatic spinal cord injury Traumatic spinal cord injury Ligament injury and cord oedema in cervical spine trauma Combined flexion-extension cervical spine fractures with traumatic spinal cord injury Traumatic spinal cord injury - cord contusion Thoracic spine fracture-dislocation C fracture-dislocation Multiple choice questions: Question Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.
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Citation, DOI, disclosures and article data. Sheikh Z, Bell D, Yu Jin T, et al. Traumatic spinal cord injury. Reference article, Radiopaedia. Article created:. Article Google Scholar. Copley PC, Jamjoom AAB, Khan S The management of traumatic spinal cord injuries in adults: a review.
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Eur Spine J — Download references. Health Insurance Hospital in Tanta, El-geish street, Tanta, Gharbya Governorate, Egypt. Radwa Mohamed Diaa Eldeen Abd Alsamee Alkadeem. Faculty of Medicine, Tanta University, Tanta, Egypt. You can also search for this author in PubMed Google Scholar.
MH suggested the research idea, ensured the original figures and data in the work, minimized the obstacles to the team of work, correlated the study concept and design, and had the major role in analysis. RM collected data in all stages of the manuscript, performed data analysis.
HA supervised the study with significant contribution to the design of the methodology, manuscript revision and preparation. AE correlated the clinical data of the patient and matched it with the findings, drafted and revised the work. All authors read and approved the final manuscript for submission.
Correspondence to Hanan Ahmad Nagy. Informed written consent taken from the patients and healthy volunteers; the study was approved by the ethical committee of Tanta University Hospital, Faculty of Medicine.
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Reprints and permissions. Alkadeem, R. et al. Magnetic resonance diffusion tensor imaging of acute spinal cord injury in spinal trauma.
Egypt J Radiol Nucl Med 52 , 70 Download citation. Received : 28 December Accepted : 22 February Published : 02 March Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all SpringerOpen articles Search. Download PDF. Abstract Background It was important to develop a non-invasive imaging technique for early evaluation of spinal cord integrity after injury; MRI was the method of choice for evaluation of any cord abnormalities.
Results Out of the studied 30 patients, conventional MRI revealed abnormalities in the spinal cord in 23 patients Conclusion DTI can be used to detect structural changes of spinal cord white matter fibers in acute spinal cord injury.
Background Traumatic spinal cord injury TSCI is one of the most distressing injuries in human beings.
Methods Study population This prospective study was conducted on 30 patients with spinal trauma having neurological symptoms. All the included participants were subjected to magnetic resonance imaging All MRI scans were performed using a 1.
Data collection Full medical history, including personal history, mode, and timing of trauma; onset, course, and duration of current illness; past history of previous spinal trauma, spinal disease, or spinal operations. Review of all previous investigations or radiological examination.
Clinical examination Performed for all the studied patients by a neurosurgeon at the Neurosurgery Department including general examination and neurological examination for focal neurological deficits motor and sensory using The American Spinal Injury Association ASIA impairment scale modified Frankel classification as illustrated in Table 1 [ 10 ].
a Initial sagittal T2W image shows cord compression of the cervical cord with high signal change localised to the level of C indicating early cord oedema. b A repeat scan 3 days later demonstrates an increase in the length of the signal change in keeping with longitudinal extension of the cord oedema.
Gradient echo sequences should be used, as spin echo sequences may understate the degree of cord haematoma. Haemorrhagic contusion. a T2W sagittal images demonstrate an area of high signal and cord swelling within the cervical cord at the C5 level.
No low T2 signal is seen on this spin echo sequence to suggest haemorrhage. b However, T1W images demonstrate subtle increased signal indicating acute haemorrhage. There is good evidence from many studies that the presence of haemorrhage within the cord is associated with a poor neurological status on presentation, with patients more likely to have a complete SCI and worse baseline American Spinal Injury Association motor scores.
Cord Haematoma. The initial scan had demonstrated cord contusion and ongoing compression but only limited cord haemorrhage. a This sagittal T2W image from a repeat scan demonstrates the development of an extensive cord haematoma up to the level of the medulla oblongata, characterised by abnormal low signal throughout the cord with a thin rim of surrounding oedema.
This is despite the absence of any ongoing cord compression. The patient subsequently died from his injuries. Diffusion-weighted imaging is well-established in brain imaging but is more difficult to use in the cord due to the small volume of tissue, the CSF flow artefact and the inherent anisotropy of the cord tissue.
Limited evidence is available in traumatic cord injury but preliminary results suggest that cord-restricted diffusion is linked to poor neurological recovery Figure 9. Cord ischaemia. a This patient was shot in the spine but the trajectory of the bullet missed the cord itself.
This axial computed tomography image clearly depicts the trajectory and extent of bone injury open white arrows. The entry and exit wounds were small but detectable in the soft tissues of the neck. Sagittal T1W b and T2W c images demonstrate an area of high T2 signal in the cord but no tear, indicating injury is secondary to the close proximity of the blast force of the bullet rather than direct laceration.
Diffusion-weighted imaging was performed and on this B image d a focus of high signal intensity indicates an area of restricted diffusion in keeping with axonal injury. Cord ischaemia is characterised in some cases by high T2 signal and cord enlargement.
Diffusion-weighted imaging remains a challenging technique but is now available on most MR systems. As hardware and software for these develop, it is likely to become a more useful clinical tool in the context of cord injury. Cord transection is the most severe cord injury characterised by a complete disruption of the cord and high-signal CSF is seen between severed cord ends on the T2W images.
It is a rare injury seen in extreme distraction and in penetrating injury Figure In penetrating injuries, it is possible that the cord may be significantly damaged with not much bone injury evident.
In these cases, the cord injury is either due to a direct tear or secondary to blast injury from high-velocity mechanisms such as gun shots Figure 9.
Cord transection. a Schematic diagram demonstrating the appearance of cord transection on T1W and T2W images. A young woman sustained a lap-belt flexion distraction injury during a head-on motor vehicle accident. T1W b and T2W c images demonstrate tears of the flaval ligaments black arrowhead and posterior dura open black arrow.
There is a partial rent at the same level in the cord open white arrow. The cavity is filled with cerebrospinal fluid confirmed on both T1W and T2W images. Clinical issues that arise in the subacute period typically 2—6 weeks following acute injury include neurological deterioration and infection.
Pain is more commonly neuropathic and assessed clinically rather than radiologically. This is also described as progressive posttraumatic myelomalacic myelopathy.
The aetiology of this condition is debated but is likely to be due to altered CSF flow secondary to dural adhesions although ischaemic and inflammatory processes have been proposed.
The signal abnormality is characteristically central with sparing of the cord periphery. Subacute progressive ascending myelopathy.
This patient developed a progressive deterioration of motor weakness a The initial sagittal T2W image demonstrated an extensive signal abnormality and prominent syrinx formation within the cervical and thoracic cord, extending inferiorly from the mid level of the C4 vertebral body to T7.
Pedicle screw and plate fixation is seen between T3 and T4. b 6 months later, the signal change has now extended both cranially and caudally, and reaches the foramen magnum. Syrinx is defined as a fluid-filled intramedullary structure expanding above the injured segment with signal isointense to CSF.
It is usually tapered at its cephalad and caudal extents. MRI is an essential tool to define the site and nature of cord injury in addition to associated disc, ligamentous and vertebral injuries.
The MR appearances of cord haematoma, severity of maximal cord compression and length of cord oedema are all significantly associated with worse long-term functional independence scores and are important considerations in planning acute management.
Neurological deterioration in the subacute period is uncommon, but constitutes a medical emergency and MRI is pivotal in determining the underlying cause. Subacute progressive ascending myelopathy is a rare but important cause and MRI can easily differentiate this condition from other pathologies including epidural haematoma or delayed instability.
It is important that clinicians looking after the care of cord-injured patients become familiar with their MRI findings. In a time of rapidly evolving imaging techniques, close interdisciplinary liaison between radiologists and clinicians is essential to ensure that all specialties appreciate the clinical issues and the radiological—pathological correlation possible on MRI to optimise the best clinical outcome for this patient group.
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Magnetic resonance corc MRI of the spine uses radio waves, a magnetic field and a computer. It creates clear, detailed injuties MRI for spinal cord injuries the spinla and Speeding up fat metabolism tissues. MRI does MRI for spinal cord injuries use radiation and may require an injection of gadolinium contrast material. Gadolinium is less likely to cause an allergic reaction than iodine contrast material. Tell your doctor about any health problems, recent surgeries, allergies and whether you are pregnant. The magnetic field is not harmful, but it may cause some medical devices to malfunction. Most orthopedic implants pose no risk. Thank MRRI MRI for spinal cord injuries visiting nature. Injuires are using a browser version with nijuries support for CSS. To obtain Hydration products for athletes injuriees experience, we Hair growth for thick hair you MR a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. To illustrate MRI signs of acute and subacute injury with emphasis on evidence-based links to clinical outcome and implications for treatment. Description of important aspects of MRI techniques and illustration of critical MRI signs important in the assessment of spinal cord injury following trauma, in the acute and subacute stages.
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