Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome - Prospective study with 100 consecutive patients

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 [STT], canal stenosis, and disk herniation) imaging parameters were studied. Data were analyzed by using the Fisher exact test, the Mantel-Haenszel x² 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.