Using MRI, University of Toronto radiologists have been able to improve prediction of the likelihood of a full or partial recovery for patients with acute spinal cord injuries (SCI), according to a study in the June issue of the journal Radiology.
"Our study demonstrates that the possibility and extent of neurological recovery after SCI can be predicted within 48 hours after injury by rigorous assessment of MR images," said co-author Michael G. Fehlings, MD, PhD, FRCSC, professor of neurosurgery at the University of Toronto and medical director at the Krembil Neuroscience Centre at Toronto Western Hospital. "In addition," Fehlings said, "these findings could result in a more aggressive clinical strategy for patients who may appear to have a severe SCI but may indeed have the capacity for substantial neurological recovery."
An initial MRI examination is typically performed on patients with SCI to determine the degree of neurological damage, and findings can include cord hemorrhage, swelling, soft tissue and ligament injury, blood clots or herniated discs.
The study included 100 patients with traumatic cervical SCI. The group, comprised largely of man, ranged in age between 17 and 96. Complete motor and sensory SCI was seen in 26 patients, incomplete in 51 patients, and 22 patients were neurologically intact.
MRI exams were obtained within 24 to 48 hours of injury, and the researchers studied three measurable imaging parameters: maximum spinal cord compression, maximum canal compromise and length of lesion. Other factors included bleeding within the spine, swelling and soft tissue injury.
The results showed that severity of maximum spinal cord compression, bleeding and cord swelling were key indicators of a poor prognosis after SCI. However, the absence of these symptoms indicated a good chance for neurological recovery in every instance.
"Since the severity of spinal cord compression is a predictor of outcome after SCI, this study suggests that MRI may predict which patients would benefit the most from decompressive surgery," Fehlings said.
Fehlings believes that MRI should be performed on all patients with acute SCI whenever feasible because of its benefits in prognosis and benefits to overall care.