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MRI of chronic spinal cord injury

The Department of Diagnostic Imaging, The Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex HA7 4LP, UK

View larger version (166K): [in a new window]   Figure 1. (a) Sagittal T1W and (b) T2W spin echo MRI in a patient who suffered a hyperextension injury at the C3/4 level. Focal atrophy is present at the disc level, associated with on-going mild cord compression and possible central cyst formation or myelomalacia, manifest as reduced cord signal intensity on T1W and hyperintensity on T2W. Note the relative lack of artefact from the anterior instrumented fusion with titanium screws.

View larger version (95K): [in a new window]   Figure 2. Sagittal T2W fast spin echo MRI in a patient who suffered a flexion distraction injury at the T4/5 level. Extended atrophy is present both above and below the level of injury and is associated with central hyperintensity due to a small syrinx.

View larger version (160K): [in a new window]   Figure 3. (a) Sagittal T1W and (b) T2W spin echo MRI in a patient who suffered a previous dens fracture, which is now well-healed. An area of myelomalacia is evident adjacent to C2, manifest as a poorly defined region of hypointensity in the cord on T1W and hyperintensity on T2W. The signal abnormality on T1W is slightly hyperintense to cerebrospinal fluid.

View larger version (111K): [in a new window]   Figure 4. Sagittal T1W spin echo MRI in a patient who suffered a burst fracture of C5. A cyst is present in the cord at the C5 level and is associated with focal cord atrophy.

View larger version (153K): [in a new window]   Figure 5. (a) Sagittal T1W and (b) T2W spin echo MRI in a patient who suffered a hyperextension injury at the C3/4 level showing a well-defined post-traumatic spinal cord cyst.

View larger version (150K): [in a new window]   Figure 6. (a) Sagittal T1W and (b) T2W spin echo MRI in a patient who suffered a T7 and T8 burst fracture. A well defined cyst is present in the cord and is associated with slight cord expansion and adjacent myelomalacia.

View larger version (120K): [in a new window]   Figure 7. (a, b) Sagittal T1W and (c) T2W spin echo MRI in a patient who suffered a burst fracture of L1. The syrinx is septated and isointense to cerebrospinal fluid. The conus is tethered to the posterior wall of L1.

View larger version (135K): [in a new window]   Figure 8. Axial T1W spin echo MRI through the mid-thoracic region in a patient who suffered a burst fracture of T9. The syrinx expands and thins the cord.

View larger version (104K): [in a new window]   Figure 9. Sagittal T2W spin echo MRI in a patient who suffered a burst fracture of T11. The spine has been reconstructed with T11 vertebrectomy and replacement by a titanium cage/plate construct. The syrinx expands the cord, extending caudally into the conus. Regions of flow void are identified, indicating the presence of a high-pressure syrinx.

View larger version (151K): [in a new window]   Figure 10. (a) Sagittal T2W and (b) T1W spin echo MRI in a patient who suffered a T5/6 shear injury showing a focal area of cord disruption.