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Imaging of Spinal Cord Injuries


Radiography and Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)

Diffusion Tensor Imaging (DTI)

Failla S, Sharma M, Kiwan R, Sallam Y, Chan I, Li O, Wozniak A, Teasell RW. (2020). Imaging Aspects of Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Noonan VK, Loh E, Mortenson WB, McIntyre A, Queree M, editors. Spinal Cord Injury Research Evidence. Version 7.0: p 1-32.


Executive Summary

Overall studies using magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) provide strong evidence that these are important imaging tools in the diagnosis, prognosis, and evaluation of injuries associated with SCI. MRI was shown to have high sensitivity and specificity in the detection of microstructural abnormalities related to SCI, and that these observations can be used to predict motor score and classification. There is limited evidence to suggest that MRI may be useful in the diagnosis and prognosis of motor classification in individuals with SCI without radiographic abnormalities. With respect to DTI, there is strong evidence to support its use as a diagnostic tool, however the evidence surrounding its use as a prognostic indicator are mixed. In general, there are fewer studies reporting the use of DTI in relation to SCI management compared to the use of MRI.

Key Points

  • Magnetic Resonance Imaging
    • MRI is an effective diagnostic tool to assess damage to microstructures within the spinal cord as well as detecting other indications of damage such as hemorrhage and edemas.
    • MRI may be reliably used to predict an individual’s injury severity, American Spinal Injury Association score, motor score, AIS, and neurologic outcome given an SCI
    • For individuals with SCI without radiographic abnormality MRI may not be useful in determining current injury severity or predicting outcome following injury.

    Diffusion Tensor Imaging

    • DTI has value as a diagnostic imaging tool to evaluate microstructural and spinal cord abnormalities in individuals with SCI.
    • There is conflicting evidence as to which observations from DTI can be used to predict current and future outcomes.
    • DTI may be effective for predicting relationships between different SCI abnormalities within individuals.