Analysis of abnormal signal on MRI at the anterior border of intervertebral space in patients with central cord syndrome without fracture and dislocation

English Keywords:Cervical spine  Central cord syndrome  MRI  Tomography  X-ray computed

English Abstract:

  【Abstract】 Objectives: To investigate the imaging manifestations and clinical significance of abnormal signal on MRI at the anterior border of intervertebral space in patients with central cord syndrome(CCS) without fracture and dislocation. Methods: A total of 50 patients(34 males and 16 females) aged 57.2±12.4 years(26-83 years) with CCS without fracture and dislocation and accompanied with high signal intensity on T2WI at the anterior border of one single intervertebral space from January 2016 to December 2021 were included. According to signal intensity on T1WI at the corresponding area, the patients were divided into the single-high group(high signal intensity on T2WI and iso/low signal intensity on T1WI) and double-high group(high signal intensity on both T2WI and T1WI). The general data, the high-density areas on CT sagittal reconstruction image, the signal changes on T2WI at the corresponding discs and spinal cord, and the CT values measured at the anterior border of intervertebral space with abnormal signals and those measured at the adjacent segment were compared and analyzed between the two groups. Results: There were 27 patients in single-high group(20 males and 7 females) with an average age of 52.7±10.4 years(26-71 years) and an average time from injury to imaging examination of 9.5±4.8d, and traffic injury was the most common cause of injury(15/27, 55.6%). In double-high group, there were 23 patients(14 males and 9 females) with an average age of 62.6±12.7 years(32-83 years) and an average time from injury to imaging examination of 8.9±4.6d, and the common causes of injury were traffic injury(9/23, 39.1%) and fall injury(7/23, 30.4%). The age of double-high group was significantly older than that of single-high group(P=0.004), and there were no statistical differences in the injury time or distribution of abnormal signals between the two groups(P=0.455; P=0.975). Although there was no statistical difference in the incidence of the high-density area on CT image between the two groups(P=0.052), the incidence percentage in the single-high group(9/27, 33.3%) was relatively lower than that in double-high group(14/23, 60.9%). The incidence of high signal intensity in the disc in single-high group was 55.6%, which was much higher than that in double-high group(21.7%, P=0.031). The incidence of high signal intensity in the corresponding spinal cord was 70.4% and 30.4% in the two groups respectively, with statistical difference(P=0.005). The CT value of the anterior border of intervertebral space with abnormal signals in single-high group was 125±66HU, which was significantly lower than that in double-high group(232±163HU, P=0.003). Intragroup comparison showed that the CT value of the anterior border of intervertebral space with abnormal signals was significantly higher than that of the adjacent segment(P=0.038; P<0.001); The ratio of CT values between the two areas was significantly lower in the single-high group(1.3±0.7 vs 2.7±2.7, P=0.013). Conclusions: The abnormal signals on MRI at the anterior border of intervertebral space in patients with CCS without fracture and dislocation could be divided into single-high(high signal intensity on T2WI and iso/low signal intensity on T1WI) and double-high(high signal intensity on both T2WI and T1WI) changes. The former was closely related to injury in the disc and spinal cord, while the latter indicated the presence of pathological changes mainly characterized with calcification.