An ALL injury appears as focal disruption of the hypointense signal on all the sequences with associated prevertebral edema best identified on STIR images. Later on, resolution of the edema and hemorrhage reduces sensitivity of MRI to detect ligamentous injuries.ĪLL is the main stabilizing ligament of the anterior column and seen as hypointense line anterior to vertebral bodies.

Ideally MRI should be performed within 72 hours of injury as the T2 hyperintensity produced by edema improves the conspicuity of the ligaments which are seen as low signal intensity in normal state. Recently, diffusion tensor imaging (DTI) has been used to detect trauma related changes in the spinal cord which are not seen on conventional MRI technique. T2W images are very good in detecting the cord edema, and T2*W GRE images are used to detect the hemorrhage in and around the cord. Although fat-suppressed T2W images can also be used for detection of edema, STIR images provide more uniform fat suppression. STIR images are very sensitive for detection of edema and is helpful in diagnosing the soft tissue and ligamentous injuries, particularly of the interspinous or supraspinous ligaments. T1W images are mainly used for depiction of anatomy and osseous fractures. The typical MRI protocol for spinal injury includes sagittal T1 weighted (T1W) and T2 weighted (T2W) spin echo sequences, and T2* weighted (T2*W) gradient recalled echo (GRE) sequence, and sagittal short tau inversion recovery (STIR) sequences, as well as axial T2W and T2*W GRE sequences. NEXUS or CCR criteria indicate imaging and the mechanically unstable spine is anticipated. NEXUS or CCR criteria are met and there are clinical or imaging findings to suggest ligamentous injury. National Emergency X-Radiography Utilization Study (NEXUS) or Canadian Cervical-Spine Rule (CCR) criteria are met and there are clinical findings of myelopathy. To differentiate between hemorrhagic and non-hemorrhagic spinal cord injuries for the prognostic significance as the presence of hemorrhage significantly worsens the final clinical outcome.Īccording to American College of Radiology (ACR) appropriateness criteria, MRI of spine combined with CT scan is appropriate in the setting of acute spinal trauma if : To determine the stability of the cervical spine and assess the need for cervical collar in obtunded trauma patients. To exclude clinically suspected ligamentous or occult bony injuries in patients with negative radiographs. To identify spinal cord abnormalities in patients with impaired neurological status. To look for epidural hematoma or disc herniation before attempting a closed reduction of cervical facet dislocations. Radiographic and/or CT scan findings suggestive of ligamentous injury, such as prevertebral hematoma, spondylolisthesis, asymmetric disc space widening, facet joint widening or dislocations, and inter-spinous space widening. The main indications of MRI in spinal trauma include : Various limitations and pitfalls of MRI in spinal trauma imaging will also be discussed.

Illustrated cases are mainly of cervical spine trauma, but thoracolumbar spine injuries are also included where appropriate. Then, indications of MRI in spinal trauma as well as the role of MRI in diagnosing spinal cord, soft tissue injuries and occult osseous injuries will be discussed (Table 1).

In this pictorial review, we will first describe the normal anatomy of various ligamentous structures including the craniocervical junction. Notably, MRI is the modality of choice for evaluation of ligamentous and other soft tissue structures, disc, spinal cord and occult osseous injuries. While stability of the spine may be adequately assessed with CT for surgical decision making by spine surgeons, due to its increased availability in the emergency settings and its inherently superior contrast resolution, MRI has been playing an increasingly important role in the management of spinal trauma patients. Conventional radiographs and computed tomography (CT) are the initial imaging modalities used in the diagnosis of most cases of spinal injuries. Imaging plays a critical role in diagnosis of acute spinal trauma and helps in initiating prompt and accurate treatment in these patients.

Reviews of picktorial 3