MRI shows what CT cannot: cord oedema length, cord haemorrhage (the worst prognostic sign), ongoing compression by disc or haematoma, and ligamentous disruption — the report grades and localises it for surgery and prognosis.
Orient first
- Intramedullary haemorrhage predicts a complete injury; oedema length correlates with severity.
- SCIWORA/SCIWONA: injury without radiographic (CT) abnormality — MRI is essential.
- BASIC score grades axial T2 patterns (verify).
Acquire the study
- MRI spine: sagittal T1, T2, STIR; axial T2 and gradient-echo/SWI through the injury.
The manoeuvre
- Sagittal T2: cord oedema length in mm and the vertebral levels.
- Axial gradient-echo/SWI: intramedullary haemorrhage (dark blooming) — size in mm.
- Sagittal STIR: posterior ligamentous complex, anterior longitudinal ligament disruption.
- Ongoing compression: disc, epidural haematoma, bone fragments — canal diameter in mm.
- Axial T2 BASIC grade at the injury epicentre.
What confirms it
- Cord signal change at a level concordant with the neurological deficit.
What licenses you to exclude it
- Normal cord signal excludes a structural cord injury at the time of imaging.
The classic misread
- Missing an epidural haematoma compressing the cord.