Magnetic resonance imaging as a guide in the diagnosis and follow-up of spinal cord infarction.

BACKGROUND: Spinal cord infarction (SCI) is a dynamic process; it can present wide-spectrum images simulating a variety of entities. The purpose of this study is to characterize the typical magnetic resonance (MR) findings and to describe evolutions and contrast-enhanced patterns of SCIs at different stages.

METHODS: MR examinations of 15 patients (10 men and 5 women) with clinical diagnosis of SCIs were reviewed respectively. MR was performed from 3 hours to 178 days after onset of symptoms. The images studies were reviewed with special attention to the location, cord size and sequential signal changes of affected spinal cord, as well as contrast-enhanced patterns at different stages of SCIs. According to the onset time, the evolutions of SCIs were divided into 5 categories; onset within 6 hours (hyperacute), between 6 hours to 24 hours (acute), 1 day to 7 days (subacute), 7 days to 28 days and beyond 28 days (chronic stage).

RESULTS: Four patients had SCIs involving the cervical, one at the cervicothoracic region, eight at the thoracic, and two at the thoracolumbar region. Twelve out of 15 patients had abnormal signal intensity at the MR studies. Three patients showed normal MR study of clinically suspicious affected level at the age of ictus less than 2 days. The SCI was apparently demonstrated on T2WIs with hyperintensity since 1 day after onset and T1WIs with hypointensity from day 5-7. Contrast enhancement of affected cord simulating other entities was obvious on day 5-7 and peaked on day 14-21 after ictus.

CONCLUSIONS: MR is a useful means to detect and follow SCIs. Serial MR studies with contrast showed sequential changes of enhancement similar to those seen in cerebral infarcts. Knowledge of characteristic MR findings and evolutional changes at different stages of SCIs should perhaps lead to early diagnosis and, therefore, more effective management of patients.