Correlation of sequential MR imaging of the injured spinal cord with prognosis

Forty-nine patients with acute spinal cord injuries were studied sequentially with MR imaging by using 0.5 Tesla superconductive units, and sequential MR changes were correlated with the prognosis of the patients. MR images were obtained within one week of the injury and then every two to six months when possible. The Frankel classification of neurologic function was correlated with MR findings. The most frequently observed types of signal intensity patterns on MR imaging were type 0 (isointensity on both T1- and T2-weighted images) and type I (isointensity on T1- and hyperintensity on T2-weighted images). In subsequent subacute and chronic stages, type II (hypointensity on T1 and hyperintensity on T2) was most frequently observed. The evolution of type 0 was to types I and II, whereas type I usually turned into type II or remained as type I. Type III (hyperintensity on T1 and hyper-, iso- or hypointensity on T2 images) patients were few in number. There was a good correlation between MR imaging patterns and neurologic recovery for initial and subsequent MR patterns, in that type 0 showed good recovery, whereas types I and II revealed good improvement or no recovery. In addition, the extent of the high signal intensity area on initial as well as on subsequent T2-weighted images was proportionally correlated to neurologic recovery. The degree of cord compression was also important for predicting recovery of neurologic function. Findings of MR imaging of acutely injured spinal cord suggested the prognosis of spinal cord injury, especially when sequential studies were obtained.