An evaluation of the diagnostic capabilities of magnetic resonance imaging with a comparison to computerized tomography in acute spinal column injury

Abstract

191 An Evaluation of the Diagnostic Capabilities of Magnetic Resonance Imaging With a Comparison to Computerized Tomography in Acute Spinal Column Injury A E Flanders, M A Levitt/Emergency Service, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania Recently, magnetic resonance (MR) imaging has become a useful adjunct in diagnostic evaluation of soft tissue pathology. Plain radiographic and computed tomographic (CT) scanning are the present standard of care in evaluation of spinal column injury. Where CT scanning demonstrates presence and extent of skeletal injury better than plain radiography, both have been limited in providing information regarding presence and extent of soft tissue injury, primarily concerning the spinal cord and intervertebral discs. Our study was conducted to evaluate the diagnostic capabilities of MR in the setting of acute spinal column injury and to compare these results with those of CT scanning. Our study institution is a Level I and regional spinal cord trauma center. The sample population included 49 patients undergoing MR to evaluate suspected spinal column injury. Thirty-three of these patients had both MR and CT evaluation, and results were compared. Level of injury as imaged by MR and CT scanning ranged from C2 through C7. Seven percent (five) of the injuries were at C2, 7% (five) at C3, 20% (14) at C4, 37% (26) at C5, 23% (17) at C6, and 5 % (four) at C7. Seventy-one injuries were identified by MR imaging. These injuries were classified as fracture-dislocation {21 ), disc herniation (29), and spinal cord edema-contusion-transection (21). Diagnostic imaging results of patients undergoing CT scanning and MR were compared. CT scanning demonstrated 22 fracture-dislocations compared with ten on MR. MR demonstrated 19 disc protusions compared with seven on CT scanning. Additionally, MR imaged 13 cord injuries compared with zero by CT scanning. Tl-weighted echospin sequence imaging proved best for osseous injury and hemorrhag¢. T2-weighted echospin sequence imaging demonstrated spinal cord edema best. GRASS imaging proved best for disc herniation with its myelogramlike effect. MR imaging proved superior in demonstrating spinal cord pathology and intervertebral disc herniation. CT scanning was superior to MR in demonstrating osseous injury. CT imaging and MR imaging can be useful together in determining presence and extent of spinal column injury.