Magnetic resonance imaging (MRI) findings in spinal cord injury during acute and chronic phases

MRI is the gold standard imaging modality in spinal cord injury (SCI). During acute phase of SCI, conventional T1- and T2-weighted sequences as well as novel gradient echo images (GRE), short-tau inversion recovery (STIR), diffusion-weighted imaging (DWI), and functional MRI are useful in evaluating the injury characteristics required for prompt diagnosis, prognostication and monitoring the treatment of SCI. Features visible in acute SCI may be extramedullary like extradural hemorrhage, ligamentous and paraspinal damage; or intramedullary, seen as edema, hemorrhage, and compression. These lesions continue to evolve in the subacute phase with formation of syrinx and subacute progressive ascending myelopathy (SPAM). While quantitative methods using volumetry, diffusion tensor imaging (DTI) and multiparametric mapping (MPM) are employed to study chronic changes such as atrophy, demyelination, iron content and white matter integrity in order to understand neurodegeneration and neuroplasticity in SCI. Presence of these findings not only at injury site but throughout the neuraxis allows better understanding of the recovery process and utilization of these techniques as biomarkers for SCI.