Acute spinal-cord ischemia: evolution of MRI findings

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute spinal cord ischemia presents with specific Magnetic Resonance (MR) findings including focal cord enlargement, T2 hyperintensities, and gadolinium enhancement.
• Early MR imaging (MRI) may be normal in the initial hours following symptom onset, similar to acute brain ischemia.
• The predictability of MR abnormality development and progression in acute spinal cord ischemia requires further evaluation.

Purpose of the Study:

• To evaluate clinical and MRI findings in patients with acute spinal cord ischemia.
• To test the hypothesis that the development and course of MR abnormalities are predictable.
• To determine the typical temporal evolution of MRI findings in acute spinal cord ischemia.

Main Methods:

• A series of five patients with acute spinal cord ischemia were retrospectively analyzed.
• All patients underwent repeated MRI scans using a 1.5 T scanner.
• Clinical data were collected from patient charts.

Main Results:

• The study included four women and one man, with a median age of 52 years.
• Three patients had anterior spinal artery infarction, and two had transverse infarctions.
• Initial MRI scans within 24 hours were normal in four out of five patients.
• Focal cord enlargement and T2 hyperintensities became apparent after 1-2 days in all patients.
• Spinal cord enhancement was observed between 2 and 11 days after symptom onset.

Conclusions:

• Acute spinal cord ischemia exhibits a characteristic temporal course on MRI.
• MRI findings are typically normal in the acute phase, with swelling and T2 abnormalities appearing days later.
• Gadolinium enhancement occurs even later, highlighting the importance of serial imaging for diagnosis.
• Repeated MRI can increase the sensitivity and specificity for diagnosing acute spinal cord ischemia in suspected cases.