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Table 1 Role of MRI for evaluation of various acute traumatic spinal injuries

From: Role of magnetic resonance imaging in acute spinal trauma: a pictorial review

Pathologic features Role of MRI
Ligamentous injury • Higher sensitivity for detection compared to CT.
• Complete tear (seen as discontinuity of ligaments) or partial tear (seen as abnormal signal) can be differentiated.
• Helpful in guiding management by differentiating stable from unstable injuries.
Disc damages and herniations • Detection of abnormal disc signal related to traumatic herniations.
• Important to diagnose this before closed reduction as undetected disc herniations can cause worsening cord injury.
Extra medullary hemorrhage • MRI shows extent of hematoma to help in surgical planning.
• Extradural hematoma is commonly encountered and can lead to cord compression.
Vascular injuries • Enable detection of arterial injuries, which include an intimal flap, pseudoaneurysm, complete occlusion or active extravasation.
• Undetected vascular injuries can cause spinal cord infarctions.
Cord injuries • Detection of hemorrhagic and non-hemorrhagic cord injuries.
• This is the single most important role of MRI in spinal trauma evaluation.
• Visualized as abnormal cord signal with hemorrhage best seen on gradient recalled echo (GRE) type sequences.
• Presence of hemorrhage is the most important poor prognostic factor.
Acute vs old vertebral fracture • Age-indeterminate fractures identified on radiography and CT can be classified into acute and old fractures based on the presence or absence of bone marrow edema, respectively.
Benign vs malignant fracture • Differentiation of benign and malignant fractures.
• Benign fractures show horizontal band of marrow edema, concave appearance of posterior vertebral margin and lack of soft tissue mass.
• Malignant fractures show almost complete involvement of vertebral body, convex posterior margin and associated soft tissue mass.