Magnetic Resonance Imaging

In children, severe spinal-cord injury is sometimes not accompanied by corresponding abnormalities on plain radiographs or CT images (spinal-cord injury without radiographic abnormality, or SCIWORA). Magnetic resonance imaging, particularly using a contemporary 1.5 Tesla magnet, will virtually always demonstrate damage to the spinal cord parenchyma, even within hours of injury (see Fig. 8). MR imaging also accurately demonstrates ligamentous injury by the presence of

Figure 8. Cervical spinal-cord injury. T2-weighted axial MR imaging demonstrates high signal in the left hemi-spinal cord, representative of an incomplete traumatic injury. This adolescent patient presented after a motor-vehicle crash with Brown-Sequard syndrome but normal cervical radiographs and CT scans. Only MR imaging demonstrated her ligamentous and spinal-cord injuries.

blood or edema or by direct visualization of a disrupted ligament (such as the transverse ligament of C1). MRI can thus identify spinal-column injury without need for flexion and extension of a potentially unstable spine. Finally, immediate MR imaging of cervical spinal-cord edema and contusion in children and adults provides valuable prognostic information.

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