Magnetic resonance imaging in spinal cord injury without radiographic abnormalities in the spine in children

Introduction. Spinal cord (SC) injury without radiographic abnormalities, designated as SCIWORA, occurs in children with a frequency of 6 to 19% of all spinal injuries. Anatomical and physiological characteristics of children, SC contusions and impaired blood supply to the SC are decisive in the formation of SCIWORA. Given the existing connection between the degree of SC injury and clinical outcome, MRI results are an important area of SCIWORA research. Aim: to determine role of magnetic resonance imaging in the study of SC injury with SCIWORA in children. Material and methods. The study was performed in 22 children (13 boys and 9 girls) with clinical manifestations of SCIWORA, aged from 1 year to 17 years (mean age — 7.5 ± 4.5 years). All children in the acute period initially underwent computer tomography, then MRI in 9 of them. MRI was performed within the following timeframes: from 1 hour to 72 hours in the acute period and from 4 months to 36 months in the late period. MRI was performed on a Philips Achieva dStream 3 T scanner using the standard institute protocol for SC, which included: MR myelography, T2-Dixon, 3DT2-TSE, T1-WI, SWI, diffusion tensor images. Results. According to the severity of injury using the ASIA classification, children with SCIWORA were distributed as follows: 8 — grade A (complete SC injury), 6 — grade B (incomplete sensory and motor). According to MRI data, damage to the cervical part of the SC was found in 7 patients; thoracic — in 12; the cervical and thoracic parts — in 3. In this case, hematomyelia was present in 13 cases, complete rupture — in 2 cases, contusion of SC — in 2, ischemia of SC — in 2. Small foci of hematomyelia up to 1/3 of the SC diameter or edema had a favorable prognosis and in most cases passed from 3 to 5 weeks after injury. Anatomical rupture of SC and/or large foci of hematomyelia (more than 1/2 of the SC diameter) had an unfavorable prognosis, visually manifested by atrophy, cystic-glial scars, in two observations syringomyelia, and in two cases there were additionally chronic epidural hematomas. Conclusion. High-resolution MRI with sensitivity for soft tissue contrast is of great importance for identifying the location and size of all damaged spinal structures, including the SC. The algorithm for performing MRI in acute spinal injury should include T2- and T1-WI in the SE IP, STIR in the sagittal, T2-WI in the coronal and axial projections, 3D-SWI, and diffusion images. Contrast enhancement in acute spinal injury is also an element of the algorithm in some cases.