The Role of Magnetic Resonance Imaging and Computed Tomography in Spinal Cord Injury

Abstract

Traumatic injuries of the spine are associated with long-term morbidity and mortality. Timely diagnosis and appropriate management of mechanical instability and spinal cord injury are important to prevent further neurologic deterioration. Spine surgeons require an understanding of the essential imaging techniques concerning the diagnosis, management, and prognosis of spinal cord injury. We present a review in the role of computed tomography (CT) including advancements in multidetector CT (MDCT), dual energy CT (DECT), and photon counting CT, and how it relates to spinal trauma. We also review magnetic resonance imaging (MRI) and some of the developed MRI based classifications for prognosticating the severity and outcome of spinal cord injury, such as diffusion weighted imaging (DWI), diffusion tractography (DTI), functional MRI (fMRI), and perfusion MRI.

Keywords: computed tomography; diagnostic imaging; magnetic resonance imaging; spinal cord injury; spinal trauma.

Figure 1

(a) Sagittal and (b) axial view of CT showing L3 burst fracture with significant retropulsion of the vertebral body into the spinal canal and loss of body heigh. There is involvement of the posterior elements.

Figure 2

(a) Sagittal and (b) coronal view of CT showing type II dens fracture. “C1–C4” Designate each corresponding spinal level.

Figure 3

(a) Sagittal CT demonstrating no bony injury or malalignment to a trauma patient. (b) Sagittal MRI STIR sequence demonstrating cord signal change with evidence of contusion spanning from C3–C5. “C1–C7” designate each corresponding spinal level.

Figure 4

Sagittal view of STIR sequence of MRI shows signal changes in the C1/2 and C1/condyle joint.

Figure 5

(a) Sagittal and (b) axial view of T2 MRI showing severe spinal cord injury with intramedullary hemorrhage.