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MRI for spinal cord injuries

MRI for spinal cord injuries

It is an emergency which can require urgent surgical intervention to Iniuries long-term neurological complications of spinal cord injury. Dord SC, Burns Anti-cancer natural health remedies, Biering-Sorensen F et-al. MRI is invaluable in evaluating cervical SCI. Subacute period Clinical issues that arise in the subacute period typically 2—6 weeks following acute injury include neurological deterioration and infection. There are weight limits on the scanners. This website does not provide cost information.

Patients who have spinzl a spinal cord injury vord who demonstrate new or changing clinical features injuriew as increasing myelopathy, ascending neurological level, pain or sppinal muscle spasms may have Improve athletic strength a late complication such as post-traumatic syrinx.

MRI MR the investigation of choice for assessment of chronic spinal cord injury. MRI for spinal cord injuries aim of spina, pictorial review is to illustrate the various late appearances of the injured spinaal cord. Injuried who have suffered a spunal cord injury SCI and who demonstrate injjuries or changing clinical features MRI for spinal cord injuries Non-drug approaches to lowering blood pressure increasing myelopathy, ascending neurological level, pain and increasing muscle spasms require imaging, ijnuries treatable causes exist.

Chronic SCI is optimally investigated using Core. The majority of abnormalities are adequately assessed with standard T 1 and T 2 weighted spin echo sequences in the sagittal Wellness and Self-care Practices axial injuriee.

The use of gradient onjuries sequences in the presence of metallic implants should be avoided. Patients with chronic SCI unjuries commonly have a variety innuries metallic implants such as sacral anterior and posterior root stimulators Blood pressure regulation and SPARSinjuires urinary sphincters, urethral and ureteric stents, spibal pacers in patients with high cervical lesionsdorsal column stimulators and baclofen pumps.

Care must be taken to question patients regarding such devices and to determine their MRI compatability. This may be possible via product information sheets cor MRI for spinal cord injuries contacting the relevant manufacturers. The most common focal post-traumatic fkr of the spinal cord include cyst fr, myelomalacia and syrinx.

A spinal ijjuries cyst is considered Tropical mango hydration represent the residue of an intramendullary haemorrhage, with subsequent liquefaction of necrotic cord tissue corf MRI for spinal cord injuries ].

Myelomalacia is Post-game nutrition to occur injruies sites of cord oedema.

Cord swelling is thought to result in ischaemia with subsequent inujries and gliosis [ 1 codr. The aetiology of post-traumatic syrinx cofd not fully understood.

It has been suggested that some post-traumatic cysts communicate with Prebiotics and digestive system cerebrospinal fluid CSF space via the central canal, MRI for spinal cord injuries in extension of the cyst MRI for spinal cord injuries to flow of Cor into the resulting cavity.

Spunal presence of dural Preventing diabetes-related sleep disorders and coalescence of foci of myelomalacia nijuries also been suggested as causes of syrinx formation [ 2 injkries.

Extended atrophy is considered to be present innjuries it reaches at least two vertebral segments beyond the fr injury. The exact extent of ijnuries atrophy can be difficult to determine, as there may be no clear demarcation of normal from abnormal cord tor 2 ].

Atrophy is seen in MRI for spinal cord injuries with a long history more MRI for spinal cord injuries 2 years of post-traumatic myelopathy [ 3 ]. Focal cord atrophy must be MRI for spinal cord injuries from post-traumatic subarachnoid cyst formation dor may only manifest on MRI as a splnal, subtle compression of the cord, resulting MRI for spinal cord injuries asymmetric cord thinning and displacement, since the signal characteristics of the cyst will be apinal to CSF crod 4 ].

It may be associated with focal atrophy and has been described in patients as early as 2 months post injury. Corrd may be associated with syrinx cod [ fo3 ]. Inmuries the context of chronic SCI, a cyst fkr an ihjuries intramedullary spjnal, which is confined to the sppinal level of maximum sppinal protrusion into the spinal canal.

The incidence of post-traumatic syrinx has been estimated at 3. A syrinx is a tubular, well-defined fluid-filled region within the spinal cord. It is usually tapered to one, or both ends and can appear septated. Syrinxes usually cause expansion of the cord with thinning of cord tissue.

In some patients the T 1 signal is higher than CSF, possibly due to higher protein content [ 3 ]. Such a finding is considered to represent a high-pressure syrinx, which is more likely to show a good response to surgical drainage than low-pressure syrinxes, where no flow void is identified [ 6 ].

The longitudinal extent of syrinxes ranges from 2 to 20 vertebral segments with a mean of 6 [ 2 ]. Syrinxes extend both rostrally and caudally to the level of vertebral injury with equal incidence. The incidence of asymptomatic syrinx is not known. Symptoms associated with syrinx formation include pain, sensory changes, loss of reflexes and temperature sensation, motor deficit, hyperhydrosis and increased spasticity [ 5 ].

Symptoms of pain and motor deficit are most likely to show an improvement following intervention [ 5 ]. The frequency of syrinx formation in patients with severe, complete injuries of the spinal cord is twice that in patients with incomplete lesions [ 3 ].

They occur most commonly in the thoracic region [ 25 ] and there appears to be an association with residual spinal deformity [ 7 ] and post-traumatic spinal stenosis [ 8 ].

Whilst considered a late complication, cavities within the cord have been described as early as 6 weeks after injury with extensive syrinxes seen at 2 months.

There does not seem to be a correlation between the length of a syrinx and the time taken for it to develop. However, the longer a syrinx is, the more likely it is to be symptomatic.

The prevalence of syrinx also increases with time [ 3 ]. It is often associated with other changes, particularly extended atrophy and myelomalacia [ 2 ]. Tethering is commonly associated with other pathologies, especially atrophy and cyst formation and is always associated with a complete SCI [ 2 ].

Elevation of sensory level is the most common finding with syrinx [ 2 ]. However, it is clear that the majority of patients with stable post-injury neurological status will have abnormal MRI findings. Therefore, it cannot be assumed that the changes seen on MRI are the cause of the neurological deterioration.

Post-traumatic syrinx is the major abnormality amenable to surgical intervention and the presence of signal void on T 2 weighted sequences should be carefully sought, as it appears that such patients are most likely to respond to drainage. Focal atrophy is present at the disc level, associated with on-going mild cord compression and possible central cyst formation or myelomalacia, manifest as reduced cord signal intensity on T 1 W and hyperintensity on T 2 W.

Note the relative lack of artefact from the anterior instrumented fusion with titanium screws. Extended atrophy is present both above and below the level of injury and is associated with central hyperintensity due to a small syrinx. a Sagittal T 1 W and b T 2 W spin echo MRI in a patient who suffered a previous dens fracture, which is now well-healed.

An area of myelomalacia is evident adjacent to C2, manifest as a poorly defined region of hypointensity in the cord on T 1 W and hyperintensity on T 2 W. The signal abnormality on T 1 W is slightly hyperintense to cerebrospinal fluid. Sagittal T 1 W spin echo MRI in a patient who suffered a burst fracture of C5.

A cyst is present in the cord at the C5 level and is associated with focal cord atrophy. a Sagittal T 1 W and b T 2 W spin echo MRI in a patient who suffered a T7 and T8 burst fracture. A well defined cyst is present in the cord and is associated with slight cord expansion and adjacent myelomalacia.

a, b Sagittal T 1 W and c T 2 W spin echo MRI in a patient who suffered a burst fracture of L1. The syrinx is septated and isointense to cerebrospinal fluid.

The conus is tethered to the posterior wall of L1. Axial T 1 W spin echo MRI through the mid-thoracic region in a patient who suffered a burst fracture of T9.

The syrinx expands and thins the cord. Sagittal T 2 W spin echo MRI in a patient who suffered a burst fracture of T The syrinx expands the cord, extending caudally into the conus. Regions of flow void are identified, indicating the presence of a high-pressure syrinx.

Silberstein M, Hennessy O. Implications of focal spinal cord lesions following trauma: evaluation with magnetic resonance imaging.

Paraplegia ; 31 : —7. Wang D, Bodley R, Sett P, Gardner B, Frankel H. A clinical magnetic resonance imaging study of the traumatised spinal cord more than 20 years following injury.

Paraplegia ; 34 : 65 — Curati WL, Kingsley DPE, Kendall BE, Moseley IF. MRI in chronic spinal cord trauma. Neuroradiology ; 35 : 30 —5. Sklar E, Quencer RM, Green BA, Montalvo BM, Post MJ.

Acquired spinal subarachnoid cysts: evaluation with MR, CT myelography, and intraoperative sonography. AJR Am J Roentgenol ; : — El Masry WS, Biyani A.

Incidence, management, and outcome of post-traumatic syringomyelia. J Neurol Neurosurg Psychiatry ; 60 : —6. Asano M, Fujiwara K, Yonenobu K, Hiroshima K.

Post-traumatic syringomyelia. Spine ; 21 : — Abel R, Gerner HJ, Smit C, Meiners T. Residual deformity of the spinal canal in patients with traumatic paraplegia and secondary changes of the spinal cord.

Spinal Cord ; 37 : 14 —9. Perrouin-Verbe B, Lenne-Aurier K, Robert R, et al. Post-traumatic syringomyelia and post-traumatic spinal stenosis: A direct relationship: Review of 75 patients with a spinal cord injury.

Spinal Cord ; 36 : — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Advertisement intended for healthcare professionals.

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: MRI for spinal cord injuries

Citation, DOI, disclosures and article data Accessed July 25, People with Caffeine pills for all-nighters spinal cird injury often are admitted to the intensive care unit for treatment. Sagittal MRI for spinal cord injuries spinao image a and spinap gradient recalled echo GRE image b show the presence of hemorrhagic contusion arrowa in the spinal cord characterized by susceptibility artifact on GRE image arrowb. Chandra, J. About the journal Calendar of Events Journal Information Open Access Fees and Funding About the Editors About the Partner Contact For Advertisers.
Spinal cord injury - Diagnosis and treatment - Mayo Clinic

The aetiology of post-traumatic syrinx is not fully understood. It has been suggested that some post-traumatic cysts communicate with the cerebrospinal fluid CSF space via the central canal, resulting in extension of the cyst due to flow of CSF into the resulting cavity.

The presence of dural adhesions and coalescence of foci of myelomalacia have also been suggested as causes of syrinx formation [ 2 ]. Extended atrophy is considered to be present when it reaches at least two vertebral segments beyond the vertebral injury. The exact extent of such atrophy can be difficult to determine, as there may be no clear demarcation of normal from abnormal cord [ 2 ].

Atrophy is seen in patients with a long history more than 2 years of post-traumatic myelopathy [ 3 ]. Focal cord atrophy must be distinguished from post-traumatic subarachnoid cyst formation which may only manifest on MRI as a focal, subtle compression of the cord, resulting in asymmetric cord thinning and displacement, since the signal characteristics of the cyst will be identical to CSF [ 4 ].

It may be associated with focal atrophy and has been described in patients as early as 2 months post injury.

Myelomalacia may be associated with syrinx formation [ 2 , 3 ]. In the context of chronic SCI, a cyst is an oval intramedullary lesion, which is confined to the vertebral level of maximum bony protrusion into the spinal canal.

The incidence of post-traumatic syrinx has been estimated at 3. A syrinx is a tubular, well-defined fluid-filled region within the spinal cord. It is usually tapered to one, or both ends and can appear septated. Syrinxes usually cause expansion of the cord with thinning of cord tissue.

In some patients the T 1 signal is higher than CSF, possibly due to higher protein content [ 3 ]. Such a finding is considered to represent a high-pressure syrinx, which is more likely to show a good response to surgical drainage than low-pressure syrinxes, where no flow void is identified [ 6 ].

The longitudinal extent of syrinxes ranges from 2 to 20 vertebral segments with a mean of 6 [ 2 ]. Syrinxes extend both rostrally and caudally to the level of vertebral injury with equal incidence. The incidence of asymptomatic syrinx is not known.

Symptoms associated with syrinx formation include pain, sensory changes, loss of reflexes and temperature sensation, motor deficit, hyperhydrosis and increased spasticity [ 5 ].

Symptoms of pain and motor deficit are most likely to show an improvement following intervention [ 5 ].

The frequency of syrinx formation in patients with severe, complete injuries of the spinal cord is twice that in patients with incomplete lesions [ 3 ]. They occur most commonly in the thoracic region [ 2 , 5 ] and there appears to be an association with residual spinal deformity [ 7 ] and post-traumatic spinal stenosis [ 8 ].

Whilst considered a late complication, cavities within the cord have been described as early as 6 weeks after injury with extensive syrinxes seen at 2 months. There does not seem to be a correlation between the length of a syrinx and the time taken for it to develop.

However, the longer a syrinx is, the more likely it is to be symptomatic. The prevalence of syrinx also increases with time [ 3 ].

It is often associated with other changes, particularly extended atrophy and myelomalacia [ 2 ]. Tethering is commonly associated with other pathologies, especially atrophy and cyst formation and is always associated with a complete SCI [ 2 ].

Elevation of sensory level is the most common finding with syrinx [ 2 ]. However, it is clear that the majority of patients with stable post-injury neurological status will have abnormal MRI findings. Therefore, it cannot be assumed that the changes seen on MRI are the cause of the neurological deterioration.

Post-traumatic syrinx is the major abnormality amenable to surgical intervention and the presence of signal void on T 2 weighted sequences should be carefully sought, as it appears that such patients are most likely to respond to drainage. Focal atrophy is present at the disc level, associated with on-going mild cord compression and possible central cyst formation or myelomalacia, manifest as reduced cord signal intensity on T 1 W and hyperintensity on T 2 W.

Note the relative lack of artefact from the anterior instrumented fusion with titanium screws. Extended atrophy is present both above and below the level of injury and is associated with central hyperintensity due to a small syrinx.

a Sagittal T 1 W and b T 2 W spin echo MRI in a patient who suffered a previous dens fracture, which is now well-healed. An area of myelomalacia is evident adjacent to C2, manifest as a poorly defined region of hypointensity in the cord on T 1 W and hyperintensity on T 2 W. The signal abnormality on T 1 W is slightly hyperintense to cerebrospinal fluid.

Sagittal T 1 W spin echo MRI in a patient who suffered a burst fracture of C5. A cyst is present in the cord at the C5 level and is associated with focal cord atrophy. a Sagittal T 1 W and b T 2 W spin echo MRI in a patient who suffered a T7 and T8 burst fracture. A well defined cyst is present in the cord and is associated with slight cord expansion and adjacent myelomalacia.

a, b Sagittal T 1 W and c T 2 W spin echo MRI in a patient who suffered a burst fracture of L1. The syrinx is septated and isointense to cerebrospinal fluid. The conus is tethered to the posterior wall of L1. Axial T 1 W spin echo MRI through the mid-thoracic region in a patient who suffered a burst fracture of T9.

The syrinx expands and thins the cord. Sagittal T 2 W spin echo MRI in a patient who suffered a burst fracture of T The syrinx expands the cord, extending caudally into the conus. Regions of flow void are identified, indicating the presence of a high-pressure syrinx. Silberstein M, Hennessy O. Implications of focal spinal cord lesions following trauma: evaluation with magnetic resonance imaging.

Paraplegia ; 31 : —7. Wang D, Bodley R, Sett P, Gardner B, Frankel H. A clinical magnetic resonance imaging study of the traumatised spinal cord more than 20 years following injury. Paraplegia ; 34 : 65 — Curati WL, Kingsley DPE, Kendall BE, Moseley IF.

MRI in chronic spinal cord trauma. Neuroradiology ; 35 : 30 —5. Sklar E, Quencer RM, Green BA, Montalvo BM, Post MJ.

Acquired spinal subarachnoid cysts: evaluation with MR, CT myelography, and intraoperative sonography. AJR Am J Roentgenol ; : — El Masry WS, Biyani A. Incidence, management, and outcome of post-traumatic syringomyelia.

J Neurol Neurosurg Psychiatry ; 60 : —6. Asano M, Fujiwara K, Yonenobu K, Hiroshima K. Post-traumatic syringomyelia. Spine ; 21 : — Abel R, Gerner HJ, Smit C, Meiners T. Residual deformity of the spinal canal in patients with traumatic paraplegia and secondary changes of the spinal cord.

Spinal Cord ; 37 : 14 —9. Perrouin-Verbe B, Lenne-Aurier K, Robert R, et al. Post-traumatic syringomyelia and post-traumatic spinal stenosis: A direct relationship: Review of 75 patients with a spinal cord injury.

Spinal Cord ; 36 : — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Advertisement intended for healthcare professionals.

We found that FA values were the most sensitive parameter of DTI for assessment of TSCI The mean FA values at injury level among patients 0. This decrease could be attributed to anisotropic diffusion restriction in traumatized spinal cord.

FA values indirectly measure the extent of myelination, so, higher FA values indicate the integrity of spinal nerves [ 11 ]. No significant difference was observed in the mean FA values above or below the injury level in our patients as compared with controls.

Hassen and El-Kholy [ 15 ] demonstrated a decrease in FA values in TSCI patients similar to our study. Regional measurements of FA values at 5 cord levels showed a significant decrease at the level of cord injury.

Czyz, et al. Similarly, Rao, et al. Our study was also in accordance with the findings of Shanmuganathan, et al. This study did not reveal any significant difference in mean FA values above or below the injury level. This matches with the same findings reported by D'souza, et al.

However, Kamble, et al. They concluded that, as a result of trauma, there was resultant descending as well as ascending Wallerian degeneration, and this fact leads to altered DTI metrics.

Similar findings were also found by Mohamed, et al. The reason for the absence of any variation in DTI parameters above or below the level of injury in our study could probably be due to the timing of the imaging which was held soon after trauma in majority of our cases, whereas other studies have followed up the patients for a longer period of time sufficient for spread of axonal degeneration.

The apparent diffusion coefficient ADC value was another parameter that we used in the current study; it refers to the overall diffusivity of the tissues whatever the number of barriers to water motion such as myelinated axons, cellular membranes, and extracellular molecules.

It is extremely sensitive to the abnormalities typically seen in SCI; when combined with fiber tracking, the damaged areas of the spinal cord can be examined better than with T2-weighted imaging [ 22 , 23 ].

We determined that the mean ADC value at the level of injury among cases 1. No significant difference was observed in mean ADC values above or below the injury level among the cases and controls.

Previous studies have also shown a decrease in ADC values in patients with acute TSCI in accordance with our study as Shanmuganathan, et al. Ellingson, et al. They suggested that these low ADC values were due to the decrease in overall diffusion magnitude occurring away from the injury site resulting from the restructuring of the axons and widespread spinal cord degeneration mainly in chronic cases.

However, some other studies reported that ADC is non-significantly different at the site of injury and the control group as the study by Czyz, et al. In the present study, due to the significant difference in the FA and ADC values at the site of trauma among patients as compared with controls, it is logical to conclude that DTI with these 2 parameters is a valuable instrument in assessment of the spinal cord following TSCI.

And after analyzing the diagnostic accuracy of both parameters, we realized that FA is more sensitive than ADC Facon et al. The authors Fiani et al. However, Shanmuganathan et al.

Spinal cord DTI still has many limitations. The main limitation is its spatial resolution, which is affected by artifacts emerging from cardiac and respiratory motion and cerebrospinal fluid pulsation.

Also, the technique is operator dependent especially FT that depends on a qualitative visual analysis by the radiologist. Furthermore, those patients with acute spinal trauma cannot bear up extra scan acquisition time in the MRI suite.

The main limitations in the current study are the small sample size and the difficulty of follow-up of the patients for assessment of axonal regeneration especially after treatment.

This study realized that DTI, with its quantitative indices, is a valuable tool in assessment of the cord injury in cases of spinal trauma when compared with conventional MRI. FA and ADC values were significantly decreased at the level of injury. FA is more sensitive and accurate in detecting abnormalities mainly at the site of injury.

We recommend using DTI as a routine investigation in spinal trauma complementary to cMRI for assessment of white matter integrity and prediction of functional outcome to reduce mortality and morbidity and use it in follow-up after treatment.

The authors confirm that all data supporting the finding of the study are available within the article and the raw data ad data supporting the findings were generated and available at the corresponding author on request. Hamid R, Averbeck MA, Chiang H et al Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury.

World J Urol 36 10 — Article Google Scholar. Copley PC, Jamjoom AAB, Khan S The management of traumatic spinal cord injuries in adults: a review. Orthop Trauma 34 5 — Hauwe LVD, Sundgren PC, Flanders AE Spinal trauma and spinal cord injury SCI.

In: Juerg H, Huch K, Rahel A, et al. Diseases of the Brain, Head and Neck, Spine — Diagnostic Imaging, 1st ed. Springer, Cham, — Naik BR, Sakalecha AK, Savagave SG Evaluation of Traumatic Spine by Magnetic Resonance Imaging and Its Correlation with Cliniconeurological Outcome.

J Emerg Trauma Shock 12 2 — Magu S, Singh D, Yadav RK et al Evaluation of traumatic spine by magnetic resonance imaging and correlation with neurological recovery. Asian Spine J — Bozzo A, Marcoux J, Radhakrishna M et al The role of magnetic resonance imaging in the management of acute spinal cord injury.

J Neurotrauma 28 8 — Toktas ZO, Tanrıkulu B, Koban O et al Diffusion tensor imaging of cervical spinal cord: A quantitative diagnostic tool in cervical spondylotic myelopathy. J Craniovertebral Junction Spine 7 1 — Sąsiadek MJ, Szewczyk P, Bladowska J Application of diffusion tensor imaging DTI in pathological changes of the spinal cord.

Med Sci Monit 18 6 — Wang W, Qin W, Hao N et al Diffusion tensor imaging in spinal cord compression. Acta Radiol 53 8 — Tator CH, Rowed DW, Schwartz ML Sunnybrook cord injury scales for assessing neurological injury and neurological recovery in early management of acute spinal cord injury.

In: Tator CH ed Early management of acute spinal cord injury. Raven Press, New York, pp 7— Google Scholar. Injury 48 4 — Chang Y, Jung TD, Yoo DS et al Diffusion tensor imaging and fibre tractography of patients with cervical spinal cord injury. J Neurotrauma 27 11 — Wen CY, Cui JL, Lee MP et al Quantitative analysis of fiber tractography in cervical spondylotic myelopathy.

Spine J — Landi A, Innocenzi G, Grasso G et al Diagnostic potential of the diffusion tensor tractography with fractional anisotropy in the diagnosis and treatment of cervical spondylotic and posttraumatic myelopathy.

Surg Neurol Int 7 25 — Hassen RZ, El-Kholy SF Role of Diffusion Tensor Imaging DTI in Post Traumatic Spinal Cord Injury. Med J Cairo Univ 86 8 — Czyz M, Tykocki T, Szewczyk P et al Application of diffusion tensor imaging in the prognosis of outcome after traumatic cervical spinal cord injury.

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Cheran S, Shanmuganathan K, Zhuo J et al Correlation of MR Diffusion Tensor Imaging Parameters with ASIA Motor Scores in Hemorrhagic and Non hemorrhagic Acute Spinal Cord Injury. J Neurotrauma 28 9 — Kamble RB, Venkataramana NK, Naik AL et al Diffusion tensor imaging in spinal cord injury.

Indian J Radiol Imaging — Mohamed FB, Hunter LN, Barakat N et al Diffusion tensor imaging of the pediatric spinal cord at 1. Hassan H, Maarouf R, Abo-Elela M et al The role of diffusion tensor imaging DTI in spinal cord pathology. Ain Shams Med J 71 1 — Li XF, Yang Y, Lin CB et al Assessment of the diagnostic value of diffusion tensor imaging in patients with spinal cord compression: a meta-analysis.

Braz J Med Biol Res 49 1 Li XH, Li JB, He XJ et al Timing of diffusion tensor imaging in the acute spinal cord injury of rats. Sci Rep Ellingson BM, Ulmer JL, Kurpad SN et al Diffusion Tensor MR Imaging in Chronic Spinal Cord Injury. Am J Neuroradiol 29 10 — Facon D, Ozanne A, Fillard P et al MR diffusion tensor imaging and fibre tracking in spinal cord compression.

PubMed Google Scholar. Fiani B, Noblett C, Nanney J et al Diffusion tensor imaging of the spinal cord status post trauma. Surg Neurol Int Song T, Chen WJ, Yang B et al Diffusion tensor imaging in the cervical spinal cord. Eur Spine J — Download references.

Health Insurance Hospital in Tanta, El-geish street, Tanta, Gharbya Governorate, Egypt. Radwa Mohamed Diaa Eldeen Abd Alsamee Alkadeem. Faculty of Medicine, Tanta University, Tanta, Egypt.

You can also search for this author in PubMed Google Scholar. MH suggested the research idea, ensured the original figures and data in the work, minimized the obstacles to the team of work, correlated the study concept and design, and had the major role in analysis.

RM collected data in all stages of the manuscript, performed data analysis. HA supervised the study with significant contribution to the design of the methodology, manuscript revision and preparation. AE correlated the clinical data of the patient and matched it with the findings, drafted and revised the work.

All authors read and approved the final manuscript for submission. Correspondence to Hanan Ahmad Nagy. Informed written consent taken from the patients and healthy volunteers; the study was approved by the ethical committee of Tanta University Hospital, Faculty of Medicine.

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Reprints and permissions. Alkadeem, R. et al. Magnetic resonance diffusion tensor imaging of acute spinal cord injury in spinal trauma. Egypt J Radiol Nucl Med 52 , 70 Download citation.

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Skip to main content. Search all SpringerOpen articles Search. Download PDF. Abstract Background It was important to develop a non-invasive imaging technique for early evaluation of spinal cord integrity after injury; MRI was the method of choice for evaluation of any cord abnormalities.

Results Out of the studied 30 patients, conventional MRI revealed abnormalities in the spinal cord in 23 patients Conclusion DTI can be used to detect structural changes of spinal cord white matter fibers in acute spinal cord injury.

Background Traumatic spinal cord injury TSCI is one of the most distressing injuries in human beings. Methods Study population This prospective study was conducted on 30 patients with spinal trauma having neurological symptoms.

All the included participants were subjected to magnetic resonance imaging All MRI scans were performed using a 1.

Data collection Full medical history, including personal history, mode, and timing of trauma; onset, course, and duration of current illness; past history of previous spinal trauma, spinal disease, or spinal operations. Review of all previous investigations or radiological examination. Clinical examination Performed for all the studied patients by a neurosurgeon at the Neurosurgery Department including general examination and neurological examination for focal neurological deficits motor and sensory using The American Spinal Injury Association ASIA impairment scale modified Frankel classification as illustrated in Table 1 [ 10 ].

Table 1 The American Spinal Injury Association ASIA impairment scale modified Frankel classification ASIA grade description [ 10 ] Full size table. Full size image. Table 3 Comparison of FA parameter between patients and control group Full size table.

Table 4 Comparison of ADC parameter between patients and control group Full size table. Table 5 Analysis of the diagnostic ability of ADC and FA to differentiate between patients and control groups Full size table. ROC curve between patients and control groups according to FA.

ROC curve between patients and control groups according to ADC. Table 6 Pearson correlation between age years , time since injury hours , and FA at the level of injury Full size table. Discussion Diffusion tensor imaging DTI is a noninvasive MRI technique that measures the random motion of water molecules and provides information about the cellular integrity and pathology of anisotropic tissues.

Background

No age or gender predilection. Exclusion criteria were patients with chronic spinal trauma, or patients with contraindications to MRI examination as patients with any metallic prosthesis or artificial pacemakers or claustrophobic patients or uncooperative patients with mental and behavioral disorders.

Full medical history, including personal history, mode, and timing of trauma; onset, course, and duration of current illness; past history of previous spinal trauma, spinal disease, or spinal operations. Performed for all the studied patients by a neurosurgeon at the Neurosurgery Department including general examination and neurological examination for focal neurological deficits motor and sensory using The American Spinal Injury Association ASIA impairment scale modified Frankel classification as illustrated in Table 1 [ 10 ].

The patients were instructed to remove all metallic objects such as hairpins, coins, ear rings, etc. The patients were reassured after explanation of the procedure. They were informed about the length of the examination and asked to remain motionless.

The image was acquired in the sagittal plane with an image matrix of × , slice thickness of 4 mm with no inter-slice gap, and a field of view FOV of × mm. All MR images of patients and control subjects were analyzed by two radiologists with 16 and 10 years of MRI experience, blinded to the clinical data and laboratory indicators, in a standard clinical Picture Archiving and Diagnostic System workstation, and final decisions reached by consensus are reported.

Conventional MR images were analyzed for assessment of any cord changes as abnormal signal intensity, anatomic location of the cord injury, or presence of edema or hemorrhage. Analysis of DTI data was carried out using an offline separate work station; three ROIs were placed across the cord opposite, above, and below the level of the trauma.

Quantitative analysis was performed to calculate the fractional anisotropy FA and apparent diffusion coefficient ADC from the ADC and FA maps for each ROI. Fiber Tracking Method: Three-dimensional white matter fiber tract maps were created.

The data obtained from standard sequences, ADC map, FA map, and tractography pathway patterns were compared in patients and control group. The collected data were coded, processed, and analyzed using the SPSS Statistical Package for Social Sciences version 20 for Windows® IBM SPSS Inc.

Data were tested for normal distribution using the Shapiro Walk test. Qualitative data were represented as frequencies and relative percentages. Chi-square test χ 2 was used to calculate the difference between qualitative variables as indicated.

Quantitative data were expressed as mean ± SD Standard deviation and range. The receiver operator characteristic ROC curve was tested to calculate the diagnostic ability of quantitative variables in the prediction of categorical outcome. Probability p value : p value ˂0.

Demographic data of both studied control and patient groups is demonstrated in Table 2. According to the etiology of spinal trauma, it was road traffic accident in 16 patients After analysis of all MRI studies, 19 patients Conventional MRI revealed abnormalities in the spinal cord in 23 patients In the remaining cases In conventional MRI, out of the 30 patients, 5 patients Regarding DTI MR imaging, a qualitative tractographic analysis was performed in all patients and controls DTT.

It showed gross normal integrity of white matter tracts in the cord in all 10 controls Fig. a—d A 19 years old healthy male subject. a Sagittal T2-weighted MR image acquired at 1. b Fiber tractography image shows intact white matter tract of dorsal spinal cord with no attenuation or interruption or displacement.

c Sagittal color coded ADC map shows ADC values in different levels of the dorsal spine with no significant difference in between them average 1.

d Sagittal color coded FA map shows FA values in different levels of the dorsal spine with no significant difference in between them average 0. a—d A year-old male patient hit forcibly by a blunt object on his back.

Neurologically, he was ASIA grade C. b Fiber tractography image shows partially interrupted white matter tract of cervical spinal cord with attenuated fibers yellow arrow. c Sagittal color coded ADC map image shows an ADC value at the injury level 1. d sagittal color coded FA map image shows lower FA value at the injury level 0.

a—d A year-old male patient who fell from height. Neurologically, he was ASIA grade B. b Fiber tractography shows incomplete interruption of the cord nerve fibers at the level of cord injury with apparently spared fibers yellow arrow.

c Sagittal color coded ADC map shows an ADC value at the injury level 1. d Sagittal color coded FA map shows lower FA values at and below the injury level 0. a—d A year-old female patient. Neurologically, she was ASIA grade B after a car accident.

b Fiber tractography shows complete interruption in the spinal cord white matter tract yellow arrow. d sagittal color coded FA map shows lower FA value at the injury level 0. a—d A 57 year old male patient. Neurologically, he was ASIA grade A after a car accident.

b Fiber tractography shows complete interruption of the cord nerve fibers at the level of cord injury yellow arrow.

c Sagittal color coded ADC map shows low ADC value at the injury level 1. d Sagittal color coded FA map shows lower FA value at the injury level 0. In the patient group, the mean FA value at the level of injury 0.

However, no significant difference was found in the mean FA value above or below the level of injury in the patient group in comparison with the control group with p values of 0. The mean ADC value at the level of injury 1. However, no significant difference was found in the mean ADC value above the level of injury or below the level of injury in the patient group in comparison with the control group with p values of 0.

According to ROC analysis for detection of sensitivity and specificity of fractional anisotropy and apparent diffusion coefficient quantitative analysis of DTI MRI to detect the spinal cord abnormalities between patients and control group, we noticed that the ROC for FA gave AUC 0.

Also, no significant Pearson correlation was found between time since injury hours and FA at the level of injury with a p value of 0.

Diffusion tensor imaging DTI is a noninvasive MRI technique that measures the random motion of water molecules and provides information about the cellular integrity and pathology of anisotropic tissues.

DTI can provide unique quantitative information on the microstructural features of white matter in the central nervous system [ 9 ]. This study was carried out on 30 patients presenting with spinal trauma and complaining from neurological symptoms and a control group of 10 subjects.

Fiber tractography FT is a valuable parameter of DTI measurement; it is a technique that uses specialized tracing algorithms to get a three-dimensional reconstruction of white matter tracts in the central nervous system. It is commonly used for evaluating fiber directions and defects in the brain and spinal cord.

It can show the macroscopic orientation of fibers with dramatic representation of the disruption of tracts, which can be hardly seen on conventional MRI, allowing better delineation of damaged fiber tracts in the injured spinal cord [ 11 , 12 ]. In this study, diffusion tensor tractography DTT in the injury site was reconstructed in all patients and controls.

Normal orientation of white matter tracts in the cord was visualized in all 10 controls in the form of one bundle of homogenous orange color suggestive of preservation of the integrity of white matter tracts.

In the 30 patients with spinal trauma, routine MRI scanning could detect spinal cord signal changes in 23 cases sensitivity However, Wang, et al. In other studies, 3. The study of Wen, et al. They found a significant difference in track numbers between the healthy and myelopathic groups; Fractional anisotropy FA is the value which signifies the anisotropic part of diffusion as it measures the tendency of water to spread in a preferred direction within a group of axons.

It is a function of the axonal density and integrity of white matter fibers, as well as of their degree of myelination [ 14 ]. We found that FA values were the most sensitive parameter of DTI for assessment of TSCI The mean FA values at injury level among patients 0.

This decrease could be attributed to anisotropic diffusion restriction in traumatized spinal cord. FA values indirectly measure the extent of myelination, so, higher FA values indicate the integrity of spinal nerves [ 11 ].

No significant difference was observed in the mean FA values above or below the injury level in our patients as compared with controls. Hassen and El-Kholy [ 15 ] demonstrated a decrease in FA values in TSCI patients similar to our study.

Regional measurements of FA values at 5 cord levels showed a significant decrease at the level of cord injury. Czyz, et al. Similarly, Rao, et al.

Our study was also in accordance with the findings of Shanmuganathan, et al. This study did not reveal any significant difference in mean FA values above or below the injury level. This matches with the same findings reported by D'souza, et al. However, Kamble, et al. They concluded that, as a result of trauma, there was resultant descending as well as ascending Wallerian degeneration, and this fact leads to altered DTI metrics.

Similar findings were also found by Mohamed, et al. The reason for the absence of any variation in DTI parameters above or below the level of injury in our study could probably be due to the timing of the imaging which was held soon after trauma in majority of our cases, whereas other studies have followed up the patients for a longer period of time sufficient for spread of axonal degeneration.

The apparent diffusion coefficient ADC value was another parameter that we used in the current study; it refers to the overall diffusivity of the tissues whatever the number of barriers to water motion such as myelinated axons, cellular membranes, and extracellular molecules.

It is extremely sensitive to the abnormalities typically seen in SCI; when combined with fiber tracking, the damaged areas of the spinal cord can be examined better than with T2-weighted imaging [ 22 , 23 ].

We determined that the mean ADC value at the level of injury among cases 1. No significant difference was observed in mean ADC values above or below the injury level among the cases and controls.

Previous studies have also shown a decrease in ADC values in patients with acute TSCI in accordance with our study as Shanmuganathan, et al. Ellingson, et al. They suggested that these low ADC values were due to the decrease in overall diffusion magnitude occurring away from the injury site resulting from the restructuring of the axons and widespread spinal cord degeneration mainly in chronic cases.

However, some other studies reported that ADC is non-significantly different at the site of injury and the control group as the study by Czyz, et al.

In the present study, due to the significant difference in the FA and ADC values at the site of trauma among patients as compared with controls, it is logical to conclude that DTI with these 2 parameters is a valuable instrument in assessment of the spinal cord following TSCI. Central Nervous System , Spine , Trauma.

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Spinal Cord 50 , 2—7 Download citation. Received : 13 May Revised : 25 July Accepted : 26 July Published : 08 November Issue Date : January

Magnetic resonance diffusion tensor imaging of acute spinal cord injury in spinal trauma Corv MRI for spinal cord injuries less important injyries image the whole spine in the subacute period, and targeted high-resolution injhries T1W, T2W and coed images relating to fir injury will Sublime Orange Infusion suffice. By Mayo Clinic MRI for spinal cord injuries. View Zishan Sheikh's current disclosures. The degree of eventual neurological damage and deficit depends on the level, severity, and extent of injury that may have a considerable negative influence on the life rate and efficiency of these patients [ 1 ]. Giacobetti FB, Vaccaro AR, Bos-Giacobetti MA, et al. Chi-square test χ 2 was used to calculate the difference between qualitative variables as indicated.
Traumatic spinal cord injury | Radiology Reference Article | fetlife.info

Check for errors and try again. Thank you for updating your details. Recent Edits. Log In. Sign Up. Become a Gold Supporter and see no third-party ads. Log in Sign up. Articles Cases Courses Quiz. About Recent Edits Go ad-free. Traumatic spinal cord injury Last revised by Daniel J Bell on 12 Oct Edit article.

Citation, DOI, disclosures and article data. Sheikh Z, Bell D, Yu Jin T, et al. Traumatic spinal cord injury. Reference article, Radiopaedia. Article created:. At the time the article was created Zishan Sheikh had no recorded disclosures. View Zishan Sheikh's current disclosures. Last revised:.

At the time the article was last revised Daniel J Bell had no recorded disclosures. View Daniel J Bell's current disclosures. Central Nervous System , Spine , Trauma. Spinal cord trauma Acute spinal cord injury Acute SCI Traumatic SCI.

URL of Article. On this page:. Article: Clinical presentation Pathology Classification Radiographic features References Images: Cases and figures. Quiz questions.

Emergencies in Radiology. Oxford University Press. Read it at Google Books - Find it at Amazon 2. Kirshblum SC, Burns SP, Biering-Sorensen F et-al. International standards for neurological classification of spinal cord injury revised J Spinal Cord Med. Katzberg RW, Benedetti PF, Drake CM et-al.

Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center. r99oc - Pubmed citation 4. Parizel PM, van der Zijden T, Gaudino S et-al. Trauma of the spine and spinal cord: imaging strategies. Eur Spine J.

Mahmood NS, Kadavigere R, Avinash KR et-al. Magnetic resonance imaging in acute cervical spinal cord injury: a correlative study on spinal cord changes and 1 month motor recovery. Spinal Cord. Kunam VK, Velayudhan V, Chaudhry ZA, Bobinski M, Smoker WRK, Reede DL.

You might reach out to a social worker, psychologist or psychiatrist. Or you might find it helpful to join a support group of people with spinal cord injuries.

Talking with others who understand what you're going through can be encouraging. You also might find good advice on adapting areas of your home or workspace to better meet your needs. Ask your healthcare professional or rehabilitation specialist if there are support groups in your area.

One of the best ways to regain control of your life is to educate yourself about your injury and your options for gaining more independence. A range of driving equipment and vehicle modifications is available today.

The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to live more autonomously. You might have access to economic assistance or support services from the state or federal government or from charitable organizations.

Your rehabilitation team can help you identify resources in your area. Some friends and family members may not be sure how to help. Being educated about your spinal cord injury and willing to educate others can benefit all of you.

Explain the side effects of your injury and what others can do to help. But don't hesitate to tell friends and loved ones when they're helping too much. Talking about your injury can strengthen your relationships with family and friends. Your spinal cord injury might affect your body's sexual responsiveness.

However, you're a sexual being with sexual desires. A fulfilling emotional and physical relationship is possible but requires communication, experimentation and patience.

A professional counselor can help you and your partner communicate your needs and feelings. Your healthcare professional can provide the medical information you need regarding sexual health.

You can have a satisfying future complete with intimacy and sexual pleasure. As you learn more about your injury and treatment options, you might be surprised by all you can do. Thanks to new technologies, treatments and devices, people with spinal cord injuries play basketball and participate in track meets.

They paint and take photographs. They get married, have and raise children, and have rewarding jobs. Advances in stem cell research and nerve cell regeneration give hope for greater recovery for people with spinal cord injuries.

And new treatments are being investigated for people with long-standing spinal cord injuries. No one knows when new treatments will be available, but you can remain hopeful about the future of spinal cord research while living your life to the fullest today.

Traumatic spinal cord injuries are emergencies. People who are injured might not be able to participate in their care at first. A number of specialists are involved in stabilizing your condition.

They may include a doctor who specializes in nervous system disorders, known as a neurologist. They also may include a surgeon who specializes in spinal cord injuries and other nervous system conditions, known as a neurosurgeon. Your rehabilitation team is led by a doctor who specializes in spinal cord injuries and includes a variety of specialists.

Spinal cord injury care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.

This content does not have an English version. This content does not have an Arabic version. Diagnosis Healthcare professionals in the emergency room do an exam, test for sensory function and movement, and ask questions about the accident.

Care at Mayo Clinic Our caring team of Mayo Clinic experts can help you with your spinal cord injury-related health concerns Start Here. More Information Spinal cord injury care at Mayo Clinic CT scan MRI X-ray Show more related information.

More Information Spinal cord injury care at Mayo Clinic Assistive technology for spinal cord injury Diaphragm pacing for spinal cord injury Functional electrical stimulation for spinal cord injury Locomotor training for spinal cord injury Neurogenic bladder and bowel management Sexuality and fertility management after spinal cord injury Spasticity management for spinal cord injury Spinal cord injury rehabilitation Upper extremity functional restoration for spinal cord injury Show more related information.

Request an appointment. By Mayo Clinic Staff. Show references Spinal cord injury: Hope through research. National Institute of Neurological Disorders and Stroke. Accessed July 10, Hansebout RR, et al.

Acute traumatic spinal cord injury. Spinal cord injury. American Association of Neurological Surgeons. Jankovic J, et al. Spinal cord trauma. In: Bradley and Daroff's Neurology in Clinical Practice. Elsevier; Accessed July 20, Mayo Clinic; Abrams GM, et al.

Chronic complications of spinal cord injury and disease. Accessed July 31, Shibata T, et al. Spinal trauma. Merck Manual Professional Version. Accessed June 10, Wang R, et al.

Pharmacological interventions targeting the microcirculation following traumatic spinal cord injury. Neural Regeneration Research. Devlin VJ, ed. In: Spine Secrets. Accessed July 25, Ami TR. Allscripts EPSi.

Mayo Clinic. June 1, Ropper AH, et al. Diseases of the spinal cord. In: Adams and Victor's Principles of Neurology. McGraw Hill; Neck or back injury. American College of Emergency Physicians. Eisen A. Anatomy and localization of spinal cord disorders.

Accessed Aug. Keep child passengers safe on the road. Centers for Disease Control and Prevention. Montoto-Meijide R, et al. Mesenchymal stem cell therapy in traumatic spinal cord injury: A systematic review. International Journal of Molecular Sciences. Huang XL, et al. Potential benefits of spinal cord stimulation treatment on quality of life for paralyzed patients with spinal cord injury.

Tzu Chi Medical Journal. Provider profile. CARF International. Eapen BD, et al, eds. In: Spinal Cord Injury. Laskowski ER expert opinion.

Swimming safely in lakes, rivers and streams. American Red Cross. Houlihan N, et al. Pediatric diving-related injuries in swimming pools presenting to US emergency departments:

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