Miyanji Firoz, Furlan Julio C, Aarabi Bizhan, Arnold Paul M, Fehlings Michael G
Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, 399 Bathurst St, West Wing, 4th Floor, Room 449, Toronto, Ontario, Canada.
Radiology. 2007 Jun;243(3):820-7. doi: 10.1148/radiol.2433060583. Epub 2007 Apr 12.
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.
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.
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.
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.
前瞻性评估脊髓损伤（SCI）后定量和定性磁共振（MR）成像评估是否与患者神经状态相关，并预测长期随访结果。
本研究纳入100例创伤性颈髓损伤患者（男79例，女21例；平均年龄45岁；年龄范围17 - 96岁）。获得伦理委员会批准并取得知情同意。美国脊髓损伤协会（ASIA）运动评分用作入院和随访时的结局指标。ASIA损伤量表用于根据损伤严重程度对患者进行分类。研究了三个定量指标（最大脊髓压迫[MSCC]、最大椎管狭窄[MCC]和损伤长度）和六个定性指标（脊髓内出血、水肿、脊髓肿胀、软组织损伤[STI]、椎管狭窄和椎间盘突出）的成像参数。采用Fisher精确检验、Mantel - Haenszel卡方检验、方差分析、协方差分析和逐步多变量线性回归对数据进行分析。
完全运动和感觉性脊髓损伤患者的MCC（P = 0.005）、MSCC（P = 0.002）和损伤长度（P = 0.005）比不完全脊髓损伤患者和无脊髓损伤患者更严重。完全脊髓损伤患者的出血（P < 0.001）、水肿（P < 0.001）、脊髓肿胀（P = 0.001）、狭窄（P = 0.01）和STI（P = 0.001）发生率也更高。MCC（P = 0.012）、MSCC（P = 0.014）和脊髓肿胀（P < 0.
