Rubén Mora-Boga1, Olalla Vázquez-Muíños2, Sonia Pértega-Díaz3, Sebastián Salvador-de la Barrera4, María E Ferreiro-Velasco4, Antonio Rodríguez-Sotillo4,5, Rosa M Meijide-Failde6, Antonio Montoto-Marqués4,5. 1. Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain. ruben.mora.boga@sergas.es. 2. Unidad de Neurorradiología. Servicio de Radiología y Radiodiagnóstico. Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain. 3. Unidad de Estadística y Epidemiología Clínica. Spanish Clinical Research Network (SCReN). Complexo Hospitalario Universitario, A Coruña, Spain. 4. Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain. 5. Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain. 6. Grupo de investigación en Terapia Celular y Medicina Regenerativa. Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Centro de Investigaciones Científicas Avanzadas (CICA). Facultad de Ciencias de la Salud, Universidade de A Coruña, A Coruña, Spain.
Abstract
STUDY DESIGN: Retrospective observational study. OBJECTIVES: Assess the relationship between Magnetic Resonance (MR) image patterns and neurological recovery in patients with Traumatic Spinal Cord Injury (TSCI). SETTING: Spinal cord injury unit in Spain. METHODS: Patients admitted for acute TSCI between January 2010 and December 2018 with a MR exam performed in the acute phase were selected. Five patterns were established: normal, single-level edema, multilevel edema, hemorrhage, and spinal cord transection. Comparisons between the ASIA Injury Severity (AIS) score and Motor Index (MI) at admission and at discharge were made. RESULTS: Collected 296 patients. Normal and cord transection patterns were excluded due to the low number of cases. Single-level edema pattern was primarily observed in cases with incomplete injuries, hemorrhage pattern in complete injuries, and multilevel edema pattern at similar percentages in complete and incomplete lesions. Improvement of the AIS score was found in 40.9% of single-level edema, 20.2% of multilevel edema, and 19.0% of hemorrhage (p = 0.042) patterns. By excluding the AIS grade D from the analyses, the figures increased to 70.3%, 52.2%, and 19.4% respectively (p < 0.001). This significant relationship was confirmed by multivariate analysis, although it was not as relevant as the examination according to ASIA-ISCoS performed at admission (p = 0.005 vs p < 0.001). Mean variation of the MI was also significantly different (p < 0.001) between the three groups: 22.6 ± 21.4 for single-level edema, 16.9 ± 21.1 for multilevel edema, and 4.5 ± 8.4 for hemorrhage. CONCLUSION: MR injury patterns observed at the acute phase are associated with the possibility of improvement of the AIS score and MI.
STUDY DESIGN: Retrospective observational study. OBJECTIVES: Assess the relationship between Magnetic Resonance (MR) image patterns and neurological recovery in patients with Traumatic Spinal Cord Injury (TSCI). SETTING: Spinal cord injury unit in Spain. METHODS: Patients admitted for acute TSCI between January 2010 and December 2018 with a MR exam performed in the acute phase were selected. Five patterns were established: normal, single-level edema, multilevel edema, hemorrhage, and spinal cord transection. Comparisons between the ASIA Injury Severity (AIS) score and Motor Index (MI) at admission and at discharge were made. RESULTS: Collected 296 patients. Normal and cord transection patterns were excluded due to the low number of cases. Single-level edema pattern was primarily observed in cases with incomplete injuries, hemorrhage pattern in complete injuries, and multilevel edema pattern at similar percentages in complete and incomplete lesions. Improvement of the AIS score was found in 40.9% of single-level edema, 20.2% of multilevel edema, and 19.0% of hemorrhage (p = 0.042) patterns. By excluding the AIS grade D from the analyses, the figures increased to 70.3%, 52.2%, and 19.4% respectively (p < 0.001). This significant relationship was confirmed by multivariate analysis, although it was not as relevant as the examination according to ASIA-ISCoS performed at admission (p = 0.005 vs p < 0.001). Mean variation of the MI was also significantly different (p < 0.001) between the three groups: 22.6 ± 21.4 for single-level edema, 16.9 ± 21.1 for multilevel edema, and 4.5 ± 8.4 for hemorrhage. CONCLUSION: MR injury patterns observed at the acute phase are associated with the possibility of improvement of the AIS score and MI.