Can the Acute MRI Features Reflect Neurological Prognosis in Patients With Cervical Spinal Cord Injury?

Publication date: Available online 10 May 2017
Source:The Spine Journal
Author(s): Akinobu Matsushita, Takeshi Maeda, Eiji Mori, Itaru Yuge, Osamu Kawano, Takayoshi Ueta, Keiichiro Shiba
Background ContextSeveral prognostic studies looked for an association between the degree of SCI, as depicted by primary MRI within 72 hours of injury, and neurologic outcome.It was not clearly demonstrated whether the MRI at any time is to correlate with neurological prognosis.PurposeThe purpose of the present study was to investigate the relationship between the acute MRI features and neurological prognosis, especially walking ability of patients with cervical spinal cord injury (CSCI). Moreover, at any point, MRI was clearly correlated with the patient's prognosis.Study Design/SettingRetrospective Image StudyPatient SampleFrom January 2010 to October 2015, 102 patients with CSCI were treated in our hospital. Patients who were admitted to our hospital within 3days after injury were included in this study. The diagnosis was 78 patients for CSCI with no or minor bony injury and 24 patients for CSCI with fracture or dislocation. 88 men and 14 women, and the mean patient age was 62.6 years (range, 16-86 years). Paralysis at the time of admission was graded as A in 32, B in 15, C in 42, and D in 13 patients on the basis of the American Spinal Injury Association (ASIA) impairment scale. CSCI with fracture or dislocation patients were performed fixation surgery and CSCI with no or minor bony injury patients were treated conservatively. Patients were followed up for average 168 days (range, 25-496 days).Outcome MeasuresNeurological evaluation was performed using ASIA motor score and the modified Frankel grade at the time of admission and discharge.MethodsMRI was performed for all patients at admission. Using the MRI sagittal images, we measured the vertical diameter of intramedullary high-intensity changed area with T2-weighted images at the injured segment. We studied separately the patients into two groups, 0-1 day admission after injury and 2-3 days admission after injury. We evaluated the relationship between the vertical diameter of T2 high-intensity changed area in MR images and neurological outcome at this two groups. This study does not contain any conflict of interest.ResultsAt 0-1 day group, there was a relationship between the vertical diameter of T2 high-intensity area in MR image and ASIA motor score at admission and at discharge, but correlation coefficient was low. (0.3766 at admission and 0.4239 at discharge) On the other hands, at 2-3 days group, there was a significant relationship between the vertical diameter of T2 high-intensity area in MR image and ASIA motor score at admission and at discharge, and correlation coefficient was very high. (0.6840 at admission and 0.5293 at discharge) About this 2-3days group, a total of 17 patients (68%) recovered to walk with or without a cane. Receiver operator characteristic (ROC) curve analysis demonstrated that the optimal vertical diameter of T2 high-intensity area cut-off value for patients who were able to walk at discharge was 45.8 mm. If the vertical diameter of T2 high-intensity area cut-off value was 45 mm, there was a significant positive correlation with being able to walk at discharge (P < 0.0001).ConclusionsFrom our study, 2-3 days after injury, a significant relationship was observed between the vertical diameter of T2 high-intensity area and the neurological prognosis at discharge. 0-1 days after injury, a relationship between the vertical diameter of T2 high-intensity area and the neurological prognosis at discharge was weak. Neurological prognosis is more correlation with MRI after 2-3 days after the injury. If the vertical diameter of T2 high-intensity area was <45 mm, the patients were able to walk with or without a cane at discharge. T2 high-intensity changed area can reflect the neurological prognosis in patients with CSCI.



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