MRI in Spine Trauma

Abstract

Spine trauma and spinal cord injury (SCI) is a major cause of morbidity and mortality worldwide. Multidetector computed tomography (CT) is the ideal imaging modality for the initial evaluation of spine trauma, although does not allow for direct visualization of the neural elements. Magnetic resonance imaging (MRI) remains the gold standard for diagnosing soft tissue injury, providing the exceptional contrast resolution needed to display the internal architecture of the spinal cord, the relationship of the cord to the surrounding structures, and the integrity of other spinal elements, such as nerve roots, intervertebral discs, ligaments, and muscles. Indeed, MRI informs outcome prediction and surgical intervention by enabling characterization of spinal cord hemorrhage, edema, compression, and transection. MRI is often indicated in patients who present with neurologic signs and symptoms or in obtunded patients with unreliable clinical examinations. Whereas conventional MRI excels in the macroscopic delineation of the spinal cord parenchyma, advanced MRI techniques, such as diffusion tensor imaging (DTI), are able to assess alterations in microstructural features of the spinal cord, namely, axonal integrity. In this chapter, we review the role of MRI in the diagnosis of spine trauma and highlight key findings of injury to the bony vertebral and neural elements of the spine.