# Summary

There is level 4 evidence (from one case series study; (Karpova et al., 2013), and two observational studies; (Ghasemi et al., 2015, Yasin et al., 2017) that MRI has strong inter-observer correlation, sensitivity, specificity, predictive value, and diagnostic accuracy in detecting and evaluating SCI in individuals.

There is level 5 evidence (from one case series study; (Schroeder et al., 2016) that the incidence of surgical treatment and spinal decompression is not significantly different between individuals based on the presence of signal intensity on an MRI.

There is conflicting level 3 evidence (from one cohort study; (Mabray et al., 2016), one case control study; (Seif et al., 2018), two case series; (Flanders et al., 1996), (Wilson et al., 2012), and six observational studies; (Aarabi et al., 2017, Schaefer et al., 1992, Selden et al., 1999, Song et al., 2016, Takahashi et al., 1993, Zohrabian et al., 2016) and level 5 evidence (from one observational study (Wang et al., 2016) that MRI is effective in determining microstructural measurements and can reliably predict AIS classification, motor score and status and progression of injury in individuals with SCI and controls.

There is level 5 evidence (from one cohort study; (Martinez-Perez et al., 2017) that early MRI has prognostic value in its ability to evaluate ligamentous injury and edema which are predictors of poor neurologic outcome.

There is level 5 evidence (from one observational study; (Miyanji et al., 2007) that MRI can be used to detect hemorrhage, edema, and cord swelling in individuals with SCI. A greater number of positive detections were significantly associated with increased SCI severity and American Spinal Injury Association classification.

There is level 5 evidence (from two observational studies; (Boldin et al., 2006; Shepard & Bracken 1999) that MRI may be used to predict complete SCI given the detection of hemorrhage and edema in individuals with SCI.

There is level 5 evidence (from one observational study; (Dalkilic et al., 2018) that MRI could be used to assess hematoma length and predict AIS classification at baseline.

There is level 5 evidence (from one observational study; (Matsushita et al., 2017) that MRI is effective in detecting spinal microstructures which can be used to effectively predict American Spinal Injury Association motor scores, and Frankel D scores in individuals with SCI.

There is level 5 evidence (Martinez-Perez et al., 2017) that an early MRI may have prognostic value in individuals with SCI without CT evidence of trauma.

There is level 5 evidence (from an observational study (Ouchida et al., 2016) that MRI may not be an effective diagnostic or prognostic indicator of injury in individuals diagnosed with SCI without radiographic abnormality.

There is level 3 evidence (from one case control study; Choe et al., 2017) that there may be no significant relationship between DTI incidences and total International Standard of Neurological Classification for SCI scores either at baseline or follow-up in individuals with SCI.

There is level 3 evidence (from one case control study; (D’Souza et al., 2017) that there may be a significant positive relationship between fractional anisotropy and Frankel grading system scores, but no relationship between mean diffusivity and Frankel grading system scores.

There is level 3 evidence (from seven case control studies; Choe et al., 2017, (D’Souza et al., 2017, Ellingson et al., 2008a, Facon et al., 2005, Kim et al., 2015, Shanmuganathan et al., 2008, Shanmuganathan et al., 2017) that DTI may be an effective tool to measure microstructure abnormalities in individuals with an SCI compared to healthy controls.

There is level 3 evidence (from one case control study; (Shanmuganathan et al., 2017) that axial diffusivity may be positively correlated with the presence of hemorrhagic contusion, International Standard of Neurological Classification for SCI motor scores, and spinal cord independence measure III at both baseline and follow-up.

There is level 3 evidence (from one case control study; (Shanmuganathan et al., 2017) that axial diffusivity, radial diffusivity, and mean diffusivity may be a significant predictor of International Standard of Neurological Classification for SCI motor scores, but not spinal cord independence measure III scores, for both individuals with and without SCI.

There is conflicting level 3 evidence against (from one case control study; (Ellingson et al., 2008a), and one observational study; (Wang et al., 2016) and level 3 evidence for (from one case control study; (Koskinen et al., 2013) that DTI grading may have prognostic value in determining motor and sensory scores in individuals with SCI.