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Review
. 2011 Aug;28(8):1401-11.
doi: 10.1089/neu.2009.1236. Epub 2010 Aug 30.

The role of magnetic resonance imaging in the management of acute spinal cord injury

Anthony Bozzo  1 , Judith Marcoux, Mohan Radhakrishna, Julie Pelletier, Benoit Goulet
Affiliations
Review

The role of magnetic resonance imaging in the management of acute spinal cord injury

Anthony Bozzo et al. J Neurotrauma. 2011 Aug.

Abstract

Magnetic resonance imaging (MRI) has become the gold standard for imaging neurological tissues including the spinal cord. The use of MRI for imaging in the acute management of patients with spinal cord injury has increased significantly. This paper used a vigorous literature review with Downs and Black scoring, followed by a Delphi vote on the main conclusions. MRI is strongly recommended for the prognostication of acute spinal cord injury. The sagittal T2 sequence was particularly found to be of value. Four prognostication patterns were found to be predictive of neurological outcome (normal, single-level edema, multi-level edema, and mixed hemorrhage and edema). It is recommended that MRI be used to direct clinical decision making. MRI has a role in clearance, the ruling out of injury, of the cervical spine in the obtunded patient only if there is abnormality of the neurological exam. Patients with cervical spinal cord injuries have an increased risk of vertebral artery injuries but the literature does not allow for recommendation of magnetic resonance angiography as part of the routine protocol. Finally, time repetition (TR) and time echo (TE) values used to evaluate patients with acute spinal cord injury vary significantly. All publications with MRI should specify the TR and TE values used.

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Figures

FIG. 1.
FIG. 1.
Four injury signal patterns using Sagittal T2 MRI. (a) Burst fracture of C6 and retrolisthesis of C6 on C7 by 4 mm with normal cord (pattern 1). (b) Single-level edema severe central stenosis C5–6 and C5 fracture (pattern 2). (c) Multi-level edema C1 to C5 with C3–C4 disk herniation (pattern 3). (d) Hemorrhage and surrounding edema centered at C6 (pattern 4) in patient with bilateral C5 lamina fractures, inferior facet fractures, and grade 1 anterolisthesis of C5 on C6.
FIG. 2.
FIG. 2.
Change of neurological status by sagittal T2-weighted MRI patterns.
See this image and copyright information in PMC

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