Imaging characterization and vascular topography of vertebral body infarctions in spinal cord stroke

Spinal cord stroke (SCS) is rare, and is frequently misdiagnosed. This study describes the clinical and radiological characteristics of vertebral body infarction (VBI) associated with SCS.

To assess VBI in patients with SCS, we retrospectively reviewed clinical data and magnetic resonance imaging from patients diagnosed at a specialized referral center. VBI was defined as T2-weighted hyperintensity within a vertebral body near ischemic cord lesions. Additional features, including gadolinium enhancement, lesion distribution, and exclusion of other explanations, were also analyzed. Each vertebra was evaluated for level, pattern of signal changes, and enhancement, and then correlated with lesion distribution and the related spinal arterial supply.

Among 126 patients with SCS, 15 (12 %) showed MRI evidence of VBI. Twelve patients (80 %) had multiple vertebrae affected. Of the 32 vertebrae displaying signs of VBI, 18 (56 %) were thoracic, 9 (28 %) were cervical, and 5 (16 %) were lumbar. In 80 % of SCS cases, MRI abnormalities of VBI were found at the same or lower vertebral levels as the cord lesions; these were typically hyperintense on T2-weighted and STIR sequences, with 92 % showing contrast enhancement. The location of the ischemic lesions in the vertebral bodies was anterolateral (44 %), posteromedian (22 %), hemivertebral (19 %), or posterolateral (9 %), with two vertebrae showing diffuse involvement. The spinal vascular territories included the artery of Adamkiewicz (n = 10, 67 %), the superior artery of the cervical enlargement (n = 6, 40 %), the artery of von Haller (n = 5, 33 %), and the inferior artery of the cervical enlargement in three cases (20 %).

The co-occurrence of VBI and SCS is attributable to their shared arterial supply, as MRI findings in VBI generally mirror the spinal vascular anatomy. VBI reflects vascular injury and serves as a supportive imaging sign for SCS.