Value of diffusion-weighted MR imaging in acute cervical cord injury as a predictor of outcome

Introduction We analyzed the findings of diffusion-weighted (DW) imaging using the single-shot fast spin-echo sequence in acute cervical cord injury and evaluated the usefulness of this method for predicting the prognosis.Methods Our patient group comprised 14 patients examined 2 h to 3 days after injury. First, we visually evaluated the DW imaging findings in all patients. Apparent diffusion coefficient (ADC) maps were also assessed in 13 patients. Second, we assessed follow-up magnetic resonance (MR) examinations obtained in six patients whose DW images showed hyperintensity. Third, we reviewed the functional outcome at discharge.Results The lesions showed hyperintensity in ten patients, and no abnormal signal was noted in the remaining four patients. The ADC maps showed restricted diffusion in all patients with hyperintensity on DW imaging except in one patient for whom the ADC map was unavailable. Repeated MR examinations obtained in six of the ten patients showed either myelomalacia or exacerbation. Seven of the ten patients (70%) required assistance and the other three were independent. Among the four patients without hyperintensity on DW imaging, three (75%) were independent and only one required assistance.Conclusion DW imaging in acute cervical cord injury often reveals restricted diffusion. This finding may predict an unfavorable functional prognosis.