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Spinal injuries in children: role of MR
P C Davis1, A Reisner, P A Hudgins
1Department of Radiology (Neuroradiology), Egleston Children's Hospital, Emory University, Atlanta, GA 30322.
Insights
Magnetic resonance imaging (MRI) is crucial for diagnosing pediatric spinal cord injuries. MRI findings of cord contusion or infarction correlate with persistent neurological deficits in children, aiding prognosis.
Area of Science:
- Pediatric Neurology
- Radiology
- Spinal Cord Injury Research
Background:
- Spinal cord injury (SCI) in children presents unique diagnostic challenges.
- Accurate assessment of SCI severity is vital for predicting outcomes.
Purpose of the Study:
- To determine the clinical and prognostic value of Magnetic Resonance imaging (MRI) in pediatric patients with spinal cord injury.
- To correlate MRI findings with clinical outcomes and other imaging modalities.
Main Methods:
- Fifteen pediatric patients with SCI underwent MRI within 2 months of injury.
- MRI utilized decoupled surface coils and ventilator support.
- MRI findings were retrospectively compared with clinical, CT, and radiographic data.
Main Results:
- In children with neurological deficits, MRI revealed cord lesions including hemorrhagic contusions (4/7), nonhemorrhagic contusions (1/7), and infarction (1/7).
- All children with cord lesions on MRI experienced persistent deficits.
- Children without neurological deficits showed no cord lesions on MRI, though some had associated epidural hematoma, ligamentous disruption, or bone compression.
Conclusions:
- Pediatric spinal cord injuries can involve significant cord contusion/infarction even with minimal or no bony abnormalities.
- Both hemorrhagic and nonhemorrhagic cord lesions identified by MRI are linked to persistent neurological deficits.
- MRI is a valuable tool for the diagnosis and prognosis of acute and subacute spinal cord injuries in children.
Purpose:
To define the clinical and prognostic role of MR in a pediatric population with spinal cord injury.
Methods:
Fifteen children underwent MR 12 hours to 2 months postinjury using decoupled surface coils and ventilator support as needed. MR was correlated retrospectively with clinical, CT, and radiographic findings.
Results:
On MR, of seven children with spinal cord neurologic deficits, four had hemorrhagic contusions, one had nonhemorrhagic contusion, one had extensive infarction, and one revealed a normal cord. All had persistent deficits on hospital discharge. Eight without cord neurologic deficit revealed no cord lesions on MR; this group included two with epidural hematoma, four with ligamentous disruption, and two with bone compression.
Conclusions:
Children may have extensive cord contusion and/or infarction with minor, remote, or no fracture dislocation. Because both hemorrhagic and nonhemorrhagic cord lesions found on MR were associated with significant, persistent cord deficits, the authors conclude that MR provides a practical tool for diagnosis/prognosis in children with acute/subacute spinal injury.