Differences between spinal cord injury and cervical compressive myelopathy in intramedullary high-intensity lesions on T2-weighted magnetic resonance imaging

Medicine, 2022 · DOI: http://dx.doi.org/10.1097/MD.0000000000029982 · Published: August 26, 2022

Spinal Cord Injury Medical Imaging Spinal Disorders

Simple Explanation

This study aims to differentiate between spinal cord injury (SCI) and cervical compressive myelopathy (CCM) using MRI features. It is important to distinguish between SCI and CCM because the number of patients with cervical SCI without fractures is increasing. The study found that the length of high-intensity lesions on MRI was longer in SCI patients compared to CCM patients. Also, a 'snake-eye appearance' was observed in CCM patients but not in SCI patients. A diagnostic scale was created based on lesion length, contrast ratio, and snake-eye appearance. This scale could distinguish between SCI and CCM with approximately 90% accuracy.

Study Duration

February 2012 and February 2021

Participants

60 SCI patients and 60 CCM patients

Evidence Level

Not specified

Key Findings

1
The longitudinal length of T2 high-intensity lesions was significantly longer in SCI patients than in CCM patients.
2
Snake-eye appearance was found in 26 of the 60 CCM patients, but not in SCI patients.
3
The contrast ratio was significantly higher in the SCI group than in the CCM group.

Research Summary

This retrospective study compared MRI features of SCI and CCM patients with intramedullary high-intensity lesions. The study measured lesion length, assessed snake-eye appearance, and calculated contrast ratios using T2 values. Key findings included significantly longer lesion length and higher contrast ratio in SCI patients, and the presence of snake-eye appearance in CCM patients. These differences were used to create a diagnostic scale. The diagnostic scale, incorporating lesion length, contrast ratio, and snake-eye appearance, distinguished SCI from CCM with approximately 90% accuracy, offering a potential tool for improved diagnosis.

Practical Implications

Improved Diagnosis

The diagnostic scale developed can help differentiate between SCI and CCM with high accuracy, aiding in accurate diagnosis.

Treatment Planning

Accurate differentiation between SCI and CCM can guide appropriate treatment strategies, including surgical intervention.

Research

The study provides quantitative MRI markers that can be used in future research to understand the pathophysiology of SCI and CCM.

Study Limitations

1
The number of cases may not be sufficient to demonstrate the high diagnostic accuracy of our diagnostic scale.
2
Patients with severe SCI were included in the SCI group.
3
As the location and shape of T2 high-intensity lesions vary from patient to patient, the method for selecting slices to measure lesions was qualitative.

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