Deep tissue injury in patients with spinal cord injury: a magnetic resonance imaging-based risk assessment study

Cross-sectional observational study.

Deep-tissue injury (DTI) originates in subcutaneous soft tissue and progresses outward without early skin changes, making diagnosis difficult in people with spinal-cord injury (SCI). We evaluated the incidence of DTI with magnetic resonance imaging (MRI) and sought associated risk factors.

Kibikogen Rehabilitation Center for Employment Injuries, Japan.

Fifty-six wheelchair-dependent adults with SCI of at least 1 month's duration underwent pelvic sagittal STIR MRI screening. DTI-positive sites were defined by signal changes in subcutaneous fat or muscle. Ultrasonography, body composition, seating-related variables, and laboratory data were collected concurrently. Univariate and multivariate logistic-regression analyses identified independent risk factors.

MRI detected subclinical DTI in 33 of 112 ischial regions (29.5%). Ultrasonography was concordant in only 15 sites (45.5%). Multivariable analysis showed that longer daily wheelchair use (p = 0.018), greater subcutaneous-tissue thickness at the ischial tuberosities (p = 0.028), and less-frequent pressure-relief manoeuvres (p = 0.031; protective) were independently associated with DTI. BMI, peak interface pressure, and routine haematologic or nutritional markers were not significant.

MRI screening revealed subclinical DTI in nearly one-third of wheelchair-dependent patients with SCI and outperformed ultrasonography for early detection. Extended sitting time, thicker subcutaneous fat at the ischial tuberosity, and infrequent pressure relief emerged as modifiable risk factors. A risk-based MRI surveillance strategy may enable timely preventive interventions and reduce progression to overt pressure ulcers.