Original Research

Correlation of blunt cervical spinal cord injury magnetic resonance imaging tractography with the American Spinal Injury Association impairment scale motor scores

Orapeleng Seboco, Fekade Gebremariam, Gina Joubert
South African Journal of Radiology | Vol 25, No 1 | a2038 | DOI: https://doi.org/10.4102/sajr.v25i1.2038 | © 2021 Orapeleng Seboco, Fekade Gebremariam, Gina Joubert | This work is licensed under CC Attribution 4.0
Submitted: 31 October 2020 | Published: 01 April 2021

About the author(s)

Orapeleng Seboco, Department of Clinical Imaging Science, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
Fekade Gebremariam, Department of Clinical Imaging Science, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
Gina Joubert, Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa


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Abstract

Background: The introduction of the Subaxial Cervical Spine Injury Classification system has created the need for a holistic imaging approach that encompasses both functional (neurological) and morphological information.

Objectives: This study aimed to determine if there was a correlation between the blunt cervical spinal cord injury diffusion tensor imaging (DTI) fraction anisotropy (FA) value and the American Spine Injury Association (ASIA) impairment scale motor score.

Method: Diffusion tensor imaging was performed on 26 patients with blunt cervical spine injury (all men with a median age of 46 years) admitted to the Pelonomi Tertiary Hospital spinal unit. Imaging was performed using the 1.5T Siemens Magnetom Aera machine’s built-in spine DTI protocol. Sagittal FA values were acquired at four different cervical spine regions (medulla oblongata, above the injury site, at the injury site and below the injury site).

Results: Eight of the 26 patients had complete neurological fallout. Of the participants, 30% had injuries at the C4/C5 level, whilst injuries involving segments below and above C4/C5 affected 15% and 55% of participants, respectively. Injury site FA values (median 0.30) were significantly lower (p < 0.001) than the above injury site FA (median 0.46, p = 0.26) and below injury site FA (median 0.42 and p = 0.019). A significant correlation was noted between the injury site FA values and the ASIA impairment scale motor scores (p = 0.001, r = 0.87).

Conclusion: FA value showed excellent correlation with the ASIA impairment scale motor scores.


Keywords

diffusion tensor imaging; cervical spine injury; spine trauma; ASIA; fractional anisotropy; subaxial cervical spine injury classification; apperant diffusion coefficient

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