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Diffusion Weighted Imaging In Spinal Cord Infarction 2013

Category General Spine Yang Tang
Max Wintermark, MD
Purpose Cord infarction is a rare albeit important differential diagnosis in patients who present with acute myelopathy. The purpose of this study is to determine whether DWI is sensitive and specific for diagnosing this condition. Materials & Methods Cervical/thoracic MRI containing DWI sequences performed during the past three years to evaluate possible cord infarction were retrospectively reviewed. These sequences include axial echo planar and/or sagittal HASTE DWI with corresponding ADC maps. Patients with restricted diffusion in the cord were identified and their charts were reviewed to determine whether the final clinical diagnosis, which was based on history, neurological exam and laboratory findings concur with the presumptive MRI diagnosis of cord infarction. Results 1. None of the patients with normal diffusion signal developed cord infarction. 2. Among the 6 patients with restricted diffusion in the cervical (3) and thoracic (3) cord, 4 were confirmed to have cord infarction as the final clinical diagnosis according to chart review. These include 2 patients with thoracic cord infarction after repair of thoracic and abdominal aortic aneurysm. One trauma patient with atlantooccipital dislocation, developed cervical cord infarction, presumably due to injury to the anterior spinal artery. The fourth patient with cervical cord infarction had significant atherosclerotic risk factors. 3. For the last 2 patients with postive DWI, their final clinical diagnosis were discordant.  One patient was eventually diagnosed as neuromyelitis optica, and the other patient was determined to have postinfectious transverse myelitis. Pic 2.tif Pic 5.tif Pic 1.tif Picture 4.tif Conclusion We conclude that DWI is a sensitive technique to detect and confirm cord infarction. However, positive DWI finding should be interpretated with caution, as demyelinating/inflammatory pathology can occasionally cause restricted diffusion in the cord. References 1. Thurnher MM, Bammer R. Diffusion-weighted MR imaging (DWI) in spinal cord ischemia. Neuroradiology. 2006;48:795-801. 2. Weidauer S, Nichtweiss M, Lanfermann H, Zanella FE. Spinal cord infarction: MR imaging and clinical features in 16 cases. Neuroradiology. 2002;44:851-857. 3. Cheshire WP, Santos CC, Massey EW, Howard JF,Jr. Spinal cord infarction: etiology and outcome. Neurology. 1996;47:321-330.