Prognostic value of changes in spinal cord signal intensity on magnetic resonance imaging in patients with cervical compressive myelopathy

Abstract Nineteen patients were examined for cervical spondylotic myelopathy with magnetic resonance imaging. Pre- and postoperative magnetic resonance scans were obtained in most cases. Surgical confirmation of the pathological condition was obtained for all 19 patients. On the T2-weighted scans, there was increased signal intensity within the spinal cord at the point of maximal compression. The exact cause of the increased signal intensity on the T2-weighted images is not known, but is suspected to represent edema, inflammation, vascular ischemia, myelomalacia, or gliosis. The increased signal intensity diminished postoperatively in the patients who improved clinically, and remained the same or increased in those whose conditions remained unchanged or worsened after decompression. The authors suggest that these T2-weighted images carry prognostic significance.

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Central Spinal Cord Injury: Magnetic Resonance Imaging Confirmation and Operative Considerations

Neurosurgery ◽

10.1227/00006123-198802000-00011 ◽

1988 ◽

Vol 22 (2) ◽

pp. 340-347 ◽

Cited By ~ 29

Author(s):

John L. Fox ◽

Louis Wener ◽

Dale C. Drennan ◽

Herbert J. Manz ◽

Daniel J. Won ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Magnetic Resonance ◽

Signal Intensity ◽

High Signal ◽

Proton Density ◽

Resonance Imaging ◽

Cord Injury ◽

Central Cord Syndrome

Abstract A case of central cervical spinal cord injury, confirmed by magnetic resonance imaging (MRI) and treated by myelotomy, is presented. After recovering well from his central cord syndrome and walking with assistance, the patient developed a rapidly progressive myelopathy beginning 2 months after injury. His main injury localized clinically to the C8, T1 level; but central cord abnormalities were identified 3 months after injury at the C6 level by MRI: a high signal intensity on the proton density sequence and a low-signal intensity on the T1-weighted sequence. At operation 4½; months after his injury and 1 month after complete paraplegia, a myelotomy at C6 failed to reveal any cavity (syrinx) but instead disclosed only intense gliosis inside a slightly atrophic spinal cord. Rapid clinical improvement ensued. Secondary syringomyelia may be an endstage condition after spinal cord insults that trigger a progressive, pathophysiological reaction leading to central cord necrosis. In selected cases, myelotomy may interrupt this MRI-identified, nosogenic process before cavitation has occurred. (Neurosurgery 22:340-347, 1988)

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Assessment of Spinal Cord Compression by Magnetic Resonance Imaging—Can It Predict Surgical Outcomes in Degenerative Compressive Myelopathy? A Systematic Review

Spine ◽

10.1097/brs.0b013e31829609a0 ◽

2013 ◽

Vol 38 (16) ◽

pp. 1409-1421 ◽

Cited By ~ 26

Author(s):

Alina Karpova ◽

Ranganathan Arun ◽

David W. Cadotte ◽

Aileen M. Davis ◽

Abhaya V. Kulkarni ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Systematic Review ◽

Spinal Cord ◽

Magnetic Resonance ◽

Spinal Cord Compression ◽

Surgical Outcomes ◽

Cord Compression ◽

Resonance Imaging ◽

Compressive Myelopathy

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Magnetic Resonance Imaging Features of Intramedullary Spinal Cord Tumors with Pathological Correlations

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.v19i1.22 ◽

2013 ◽

Vol 19 (1) ◽

pp. 51-66

Author(s):

Jureerat Thammaroj ◽

Amnat Kitkhandee ◽

Parinyaporn Tumkot ◽

Pichayen Duangtongpol ◽

Sakda Waraosawapati

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Signal Intensity ◽

Imaging Features ◽

Resonance Imaging ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Cystic Component ◽

Spinal Cord Ependymoma

Objective: The purpose of this study was to determine characteristic imaging findings of intramedullary spinal cord tumor in magnetic resonance imaging (MRI). Material and Methods: We retrospectively analyzed MRI in 15 patients with histologicaly proven intramedullary spinal cord tumors. The demographic data, MRI findings with histological findings were recorded in terms of age, location, length, morphology, signal intensity, the presence or absence of cyst and hemorrhage, enhancement pattern, other associated findings, necrosis, vascular proliferation and WHO grading. Results: Among the 15 patients, spinal cord ependymomas were eccentric 75%, well-define border 62.5% and cervicothoracic spine located 37.5%. Spinal cord astrocytomas were eccentrically located and ill-define border 85.7%, cervicothoracic and thoracic spine located 28.5%. A cystic component was seen in 87.5% of spinal cord ependymoma and 71.5% of astrocytomas. Intratumoral hemorrhage occurred in 75% of spinal cord ependymomas, and 57.1% of astrocytomas. In 12.5% of spinal cord ependymomas, a curvilinear low T2 signal, suggesting marginal hemorrhage, was seen at the upper and/or lower margins of the tumors. Twenty-five percent of spinal cord ependymoma and 57.2% of astrocytomas showed heterogeneous enhancement, while in 12.5% of spinal cord ependymomas, enhancement was homogeneous. Conclusion: Although no statistically significant characteristic MRI feature to distinguish between ependymoma and astrocytoma is detected. By percentage we found that border, length and signal intensity of tumors may help diagnosis. With pathological correlation, all of spinal cord ependymomas are mark hypervascular tumor, but astrocytomas never showed.

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Magnetic resonance imaging predictors of outcome after surgical intervention for cervical spondylotic myelopathy

International Surgery Journal ◽

10.18203/2349-2902.isj20203992 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3219

Author(s):

Sushil Bhogawar ◽

Prasanth Asher ◽

Sunilkumar Balakrishnan Sreemathyamma ◽

Anilkumar Peethambaran

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Surgical Outcome ◽

Signal Intensity ◽

Cervical Spondylotic Myelopathy ◽

Surgical Intervention ◽

Resonance Imaging ◽

Group A ◽

Group B

Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.

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Postoperative changes in spinal cord signal intensity in patients with cervical compression myelopathy: comparison between preoperative and postoperative magnetic resonance images

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/6/524 ◽

2008 ◽

Vol 8 (6) ◽

pp. 524-528 ◽

Cited By ~ 47

Author(s):

Yasutsugu Yukawa ◽

Fumihiko Kato ◽

Keigo Ito ◽

Yumiko Horie ◽

Tetsurou Hida ◽

...

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Surgical Outcomes ◽

Signal Intensity ◽

Magnetic Resonance Images ◽

Mr Images ◽

Japanese Orthopedic Association ◽

Postoperative Changes ◽

Cervical Compressive Myelopathy ◽

Compressive Myelopathy

Object Increased signal intensity of the spinal cord on magnetic resonance (MR) imaging was classified pre- and postoperatively in patients with cervical compressive myelopathy. It was investigated whether postoperative classification and alterations of increased signal intensity could reflect the postoperative severity of symptoms and surgical outcomes. Methods One hundred and four patients with cervical compressive myelopathy were prospectively enrolled. All were treated using cervical expansive laminoplasty. Magnetic resonance imaging was performed in all patients preoperatively and after an average of 39.7 months postoperatively (range 12–90 months). Increased signal intensity of the spinal cord was divided into 3 grades based on sagittal T2-weighted MR images as follows: Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The severity of myelopathy was evaluated according to the Japanese Orthopedic Association (JOA) score for cervical myelopathy and its recovery rate (100% = full recovery). Results Increased signal intensity was seen in 83% of cases preoperatively and in 70% postoperatively. Preoperatively, there were 18 patients with Grade 0 increased signal intensity, 49 with Grade 1, and 37 with Grade 2; postoperatively, there were 31 with Grade 0, 31 with Grade 1, and 42 with Grade 2. The respective postoperative JOA scores and recovery rates (%) were 13.9/56.7% in patients with postoperative Grade 0, 13.2/50.7% in those with Grade 1, and 12.8/40.1% in those with Grade 2, and these differences were not statistically significant. The postoperative increased signal intensity grade was improved in 16 patients, worsened in 8, and unchanged in 80 (77%). There was no significant correlation between the alterations of increased signal intensity and surgical outcomes. Conclusions The postoperative increased signal intensity classification reflected postoperative symptomatology and surgical outcomes to some extent, without statistically significant differences. The alteration of increased signal intensity was seen postoperatively in 24 patients (23%) and was not correlated with surgical outcome.

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