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Role of magnetic resonance imaging features in diagnosing and localization of disc rupture related to cervical spinal cord injury without radiographic abnormalities

Spinal Cord volume 61, pages 323–329 (2023)Cite this article

Subjects

Abstract

Study design

A retrospective study.

Objective

Traumatic cervical spinal cord injury (TSCI) is often associated with disc rupture. It was reported that high signal of disc and anterior longitudinal ligament (ALL) rupture on magnetic resonance imaging (MRI) were the typical signs of ruptured disc. However, for TSCI with no fracture or dislocation, there is still difficult to diagnose disc rupture. The purpose of this study was to investigate the diagnostic efficiency and localization method of different MRI features for cervical disc rupture in patient with TSCI but no any signs of fracture or dislocation.

Setting

Affiliated hospital of University in Nanchang, China.

Methods

Patients who had TSCI and underwent anterior cervical surgery between June 2016 and December 2021 in our hospital were included. All patients received X-ray, CT scan, and MRI examinations before surgery. MRI findings such as prevertebral hematoma, high-signal SCI, high-signal posterior ligamentous complex (PLC), were recorded. The correlation between preoperative MRI features and intraoperative findings was analyzed. Also, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these MRI features in diagnosing the disc rupture were calculated.

Results

A total of 140 consecutive patients, 120 males and 20 females with an average age of 53 years were included in this study. Of these patients, 98 (134 cervical discs) were intraoperatively confirmed with cervical disc rupture, but 59.1% (58 patients) of them had no definite evidence of an injured disc on preoperative MRI (high-signal disc or ALL rupture signal). For these patients, the high-signal PLC on preoperative MRI had the highest diagnostic rate for disc rupture based on intraoperative findings, with a sensitivity of 97%, specificity of 72%, PPV of 84% and NPV of 93%. Combined high-signal SCI with high-signal PLC had higher specificity (97%) and PPV (98%), and a lower FPR (3%) and FNR (9%) for the diagnosis of disc rupture. And combination of three MRI features (prevertebral hematoma, high-signal SCI and PLC) had the highest accuracy in diagnosing traumatic disc rupture. For the localization of the ruptured disc, the level of the high-signal SCI had the highest consistency with the segment of the ruptured disc.

Conclusion

MRI features, such as prevertebral hematoma, high-signal SCI and PLC, demonstrated high sensitivities for diagnosing cervical disc rupture. High-signal SCI on preoperative MRI could be used to locate the segment of ruptured disc.

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Fig. 1: Three different MRI features related to ruptured disc in patients with traumatic cervical SCI.
Fig. 2: Intraoperative image and corresponding preoperative MRI sequences of a patient with traumatic cervical SCI.
Fig. 3: Combination of two different MRI features for the diagnosis of disc rupture in SCI patients.
Fig. 4: The combination of three different MRI features for diagnosing disc rupture in patients with traumatic SCI.
Fig. 5: Correlation between the levels of MRI features and the segments of ruptured disc.

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Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This work is supported by the Department of Science and Technology Program of Jiangxi Province, China (No. 20223BBG71S02, 20203BBG73045), and Jiangxi Province “Double Thousand Plan” Talent Project.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China

    Wei-Jie Liao, Bo-Lin Sun, Jia-Bao Wu, Rong-Ping Zhou, Shan-Hu Huang, Zhi-Li Liu & Jia-Ming Liu

  2. Institute of Spine and Spinal Cord, Nanchang University, Nanchang, 330006, PR China

    Wei-Jie Liao, Bo-Lin Sun, Jia-Bao Wu, Rong-Ping Zhou, Shan-Hu Huang, Zhi-Li Liu & Jia-Ming Liu

  3. Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, PR China

    Ning Zhang

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Contributions

J-ML, Z-LL, and S-HH contributed to the study’s conception and design. Material preparation and data collection were performed by W-JL, B-LS, J-BW, NZ, and R-PZ. The first draft of the manuscript was written by W-JL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Correspondence to Jia-Ming Liu.

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Liao, WJ., Sun, BL., Wu, JB. et al. Role of magnetic resonance imaging features in diagnosing and localization of disc rupture related to cervical spinal cord injury without radiographic abnormalities. Spinal Cord 61, 323–329 (2023). https://doi.org/10.1038/s41393-023-00886-2

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