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  • Title: Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome--prospective study with 100 consecutive patients.
    Author: Miyanji F, Furlan JC, Aarabi B, Arnold PM, Fehlings MG.
    Journal: Radiology; 2007 Jun; 243(3):820-7. PubMed ID: 17431129.
    Abstract:
    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 [STI], canal stenosis, and disk herniation) imaging parameters were studied. Data were analyzed by using the Fisher exact test, the Mantel-Haenszel chi(2) 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.
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