Role of MRI in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis

Area of Science:

• Neurology
• Radiology
• Trauma Surgery

Background:

• The role of magnetic resonance imaging (MRI) in acute spinal cord injury (SCI) management requires further clarification.
• Recent evidence highlights the potential utility of MRI in guiding acute SCI care.

Purpose of the Study:

• To systematically review and meta-analyze the existing literature on MRI's role in acute SCI.
• To assess MRI's diagnostic accuracy, impact on clinical decision-making, safety, and patient outcomes.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Searches of Medline, Embase, and CENTRAL databases up to March 2026.
• Inclusion of 79 studies addressing key questions on MRI in acute SCI.

Main Results:

• MRI is safe in acute SCI (0% adverse events in 412 patients).
• High sensitivity for ligamentous injury (92%) and disc herniation (96%) with advanced sequences.
• MRI alters management in 41% of cases and improves neurological outcomes (OR 1.78).
• Ultra-early MRI (<12h) shows better outcomes than delayed MRI (OR 1.54).

Conclusions:

• High-quality evidence supports routine MRI use in acute SCI.
• MRI is safe, identifies critical findings, influences management, and improves neurological outcomes.
• Integrating MRI into clinical pathways enhances patient care for acute SCI.