S G Worthley1, E D Reis, G Helft, M I Worthley, Z A Fayad. 1. Department of Radiology, The Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA. stephen.worhley@adelaide.edu.au
Abstract
BACKGROUND: Paraplegia complicating surgical thoracoabdominal aneurysm (TAA) repair remains an unpredictable and poorly understood phenomenon. The ability to identify patients at increased risk of delayed paraplegia before the process becomes irreversible could allow early interventions to attenuate this risk. METHODS: In a rabbit model of infra-renal spinal cord ischemia, serial T2 weighted (T2W) magnetic resonance (MR) imaging was performed 2- and 8 h after the ischemic insult with changes correlated with clinical outcome. Using the axial T2W images, signal intensity measurements of the lateral horns of the spinal cord were acquired, both above (that is, thoracolumbar cord) and below (that is, lumbar cord) the renal arteries. This ratio (lumbar/thoracolumbar cord signal intensity) was evaluated and compared between groups. RESULTS: No changes were seen in the signal intensity of rabbits that remained neurologically intact. Rabbits with delayed paralysis showed a significant (P<0.01) decrease in signal intensity ratio at 2 h (1.13+/-0.03), while a significant (P<0.01) increase was noted in those rabbits with immediate persistent paralysis (1.43+/-0.04). There was a significant (P<0.01) increase in the signal intensity ratios at 2 h in the delayed paralysis group (1.55+/-0.14), with a further significant (P<0.01) increase at 8 h in the immediate persistent paralysis group (1.76+/-0.07). CONCLUSIONS: Findings on MR imaging can differentiate clinical outcomes in this experimental model of spinal cord ischemia. While further studies are required, MR could be useful in predicting which patients are at risk for delayed paraplegia after TAA repair.
BACKGROUND:Paraplegia complicating surgical thoracoabdominal aneurysm (TAA) repair remains an unpredictable and poorly understood phenomenon. The ability to identify patients at increased risk of delayed paraplegia before the process becomes irreversible could allow early interventions to attenuate this risk. METHODS: In a rabbit model of infra-renal spinal cord ischemia, serial T2 weighted (T2W) magnetic resonance (MR) imaging was performed 2- and 8 h after the ischemic insult with changes correlated with clinical outcome. Using the axial T2W images, signal intensity measurements of the lateral horns of the spinal cord were acquired, both above (that is, thoracolumbar cord) and below (that is, lumbar cord) the renal arteries. This ratio (lumbar/thoracolumbar cord signal intensity) was evaluated and compared between groups. RESULTS: No changes were seen in the signal intensity of rabbits that remained neurologically intact. Rabbits with delayed paralysis showed a significant (P<0.01) decrease in signal intensity ratio at 2 h (1.13+/-0.03), while a significant (P<0.01) increase was noted in those rabbits with immediate persistent paralysis (1.43+/-0.04). There was a significant (P<0.01) increase in the signal intensity ratios at 2 h in the delayed paralysis group (1.55+/-0.14), with a further significant (P<0.01) increase at 8 h in the immediate persistent paralysis group (1.76+/-0.07). CONCLUSIONS: Findings on MR imaging can differentiate clinical outcomes in this experimental model of spinal cord ischemia. While further studies are required, MR could be useful in predicting which patients are at risk for delayed paraplegia after TAA repair.