Intrinsic cervical spinal cord deformation on MRI: "the distorted 'H' sign"

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Spinal cord pathologies can alter its gross appearance.
• Internal spinal cord abnormalities are challenging to visualize with conventional imaging.
• Magnetic resonance (MR) imaging offers potential for detailed internal spinal cord assessment.

Purpose of the Study:

• To evaluate the utility of MR imaging in visualizing internal spinal cord morphology.
• To assess the impact of lesion size on the visualization of the central gray matter's "H" configuration.
• To compare the effectiveness of different MR field strengths in depicting spinal cord internal architecture.

Main Methods:

• Review of 55 abnormal cervical spine 1.5-Tesla (T) MR imaging studies.
• Analysis of lesion size and its effect on the "H" configuration.
• Comparison of "H" visualization across 125 additional patients using MR scanners of varying field strengths (1.5 T to 0.5 T).

Main Results:

• Of 37 large lesions, 31 deformed the "H" configuration, while 18 small lesions did not.
• Visualization of the "H" configuration decreased from 51.4% at 1.5 T to 18.4% at 0.5 T.
• Higher MR field strength correlates with improved visualization of the spinal cord's internal "H" structure.

Conclusions:

• MR imaging, particularly at higher field strengths, can effectively demonstrate distortions in the spinal cord's central gray matter "H" configuration.
• Accurate mapping of the spinal cord's internal structure using MR imaging may correlate with clinical neurological findings.
• Advanced MR techniques enhance the ability to detect and characterize internal spinal cord abnormalities.