Selden N R, Quint D J, Patel N, d'Arcy H S, Papadopoulos S M
Department of Surgery, University of Michigan, Ann Arbor, USA.
Neurosurgery. 1999 Apr;44(4):785-92; discussion 792-3. doi: 10.1097/00006123-199904000-00057.
The goal of this study was to determine the prognostic and clinical value of magnetic resonance imaging (MRI) performed within hours after cervical spinal cord injuries in human patients.
Fifty-five patients with acute cervical vertebral column and spinal cord injuries underwent MRI as part of their initial treatment at the University of Michigan Medical Center. All images were obtained within 21 hours after injury (mean, 7.8 h) and were interpreted by an attending neuroradiologist who was blinded to the clinical status of the patients. Neurological function at presentation and in long-term follow-up examinations was compared with MRI characteristics assessed immediately after the injury.
The presence and rostrocaudal length of intra-axial hematoma, the rostrocaudal length of spinal cord edema, the presence of spinal cord compression, and spinal cord compression by extra-axial hematoma were each significantly associated with poor neurological function at presentation and in long-term follow-up examinations. Although the best single predictor of long-term improvement in neurological function was the neurological function at presentation, four MRI characteristics, i.e., the presence of intra-axial hematoma, the extent of spinal cord hematoma, the extent of spinal cord edema, and spinal cord compression by extra-axial hematoma, provided significant additional prognostic information. MRI data demonstrated spinal cord compression for 27 of 55 patients (49%), leading to emergency surgery. Among patients who underwent imaging after restoration of normal vertebral alignment using closed cervical traction, 13 of 26 (50%) underwent emergency surgery for treatment of persistent, MRI-demonstrated, spinal cord compression.
Emergency MRI after spinal cord injury provides accurate prognostic information regarding neurological function and aids in the diagnosis and treatment of persistent spinal cord compression after vertebral realignment.
本研究的目的是确定人类患者颈椎脊髓损伤后数小时内进行的磁共振成像（MRI）的预后和临床价值。
55例急性颈椎椎体和脊髓损伤患者在密歇根大学医学中心接受MRI检查，作为其初始治疗的一部分。所有图像均在受伤后21小时内（平均7.8小时）获得，并由一位对患者临床状况不知情的主治神经放射科医生进行解读。将就诊时和长期随访检查时的神经功能与受伤后立即评估的MRI特征进行比较。
轴内血肿的存在及其前后长度、脊髓水肿的前后长度、脊髓受压的存在以及轴外血肿导致的脊髓受压，在就诊时和长期随访检查中均与不良神经功能显著相关。虽然神经功能长期改善的最佳单一预测指标是就诊时的神经功能，但四个MRI特征，即轴内血肿的存在、脊髓血肿的范围、脊髓水肿的范围以及轴外血肿导致的脊髓受压，提供了显著的额外预后信息。MRI数据显示55例患者中有27例（49%）存在脊髓受压，导致急诊手术。在使用闭合性颈椎牵引恢复正常椎体排列后接受成像检查的患者中，26例中有13例（50%）因持续性MRI显示的脊髓受压而接受急诊手术治疗。
脊髓损伤后的急诊MRI可提供有关神经功能的准确预后信息，并有助于诊断和治疗椎体复位后持续性脊髓受压。
