European Radiology

, Volume 24, Issue 3, pp 685–692 | Cite as

Multishot diffusion-weighted MR imaging features in acute trauma of spinal cord

  • Jin Song ZhangEmail author
  • Yi Huan
Magnetic Resonance



To analyse diffusion-weighted MRI of acute spinal cord trauma and evaluate its diagnostic value.


Conventional MRI and multishot, navigator-corrected DWI were performed in 20 patients with acute spinal cord trauma using 1.5-T MR within 72 h after the onset of trauma.


Twenty cases were classified into four categories according to the characteristics of DWI: (1) Oedema type: ten cases presented with variable hyperintense areas within the spinal cord. There were significant differences in the apparent diffusion coefficients (ADCs) between lesions and unaffected regions (t = -7.621, P < 0.01). ADC values of lesions were markedly lower than those of normal areas. (2) Mixed type: six cases showed heterogeneously hyperintense areas due to a mixture of haemorrhage and oedema. (3) Haemorrhage type: two cases showed lesions as marked hypointensity due to intramedullary haemorrhage. (4) Compressed type (by epidural haemorrhage): one of the two cases showed an area of mild hyperintensity in the markedly compressed cord due to epidural haematoma.


Muti-shot DWI of the spinal cord can help visualise and evaluate the injured spinal cord in the early stage, especially in distinguishing the cytotoxic oedema from vasogenic oedema. It can assist in detecting intramedullary haemorrhage and may have a potential role in the evaluation of compressed spinal cord.

Key Points

Multishot, navigator-corrected diffusion-weighted MRI is helpful when evaluating spinal cord injury (SCI).

Four types of SCI may be classified according to the DWI characteristics.

DWI differentiates cytotoxic from vasogenic oedema, thereby determining the centre of SCI.

DWI can assist in detecting intramedullary haemorrhage.

DWI can help evaluate the degree of compressed spinal cord.


Spinal cord injury Acute Magnetic resonance Multishot Diffusion-weighted imaging 



This study was supported by the Science and Technology Project of Shaanxi Province (2013 K12-2006), China.We thank Dr. Chi-Shing Zee, Professor of Neuroradiology,USC Keck School of Medicine,for helping us revise the manuscript.


  1. 1.
    Kulkarni MV, Bondurant FJ, Rose SL, Narayana PA (1988) 1.5 Tesla magnetic resonance imaging of acute spinal trauma. Radiographics 8:1059–1082PubMedCrossRefGoogle Scholar
  2. 2.
    Flanders AE, Schaefer DM, Doan HT, Mishkin MM, Gonzalez CF, Northrup BE (1990) Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit. Radiology 177:25–33PubMedGoogle Scholar
  3. 3.
    Kerslake RW, Jaspan T, Worthington BS (1991) Magnetic resonance imaging of spinal trauma. Br J Radiol 64:386–402PubMedCrossRefGoogle Scholar
  4. 4.
    Schwartz ED, Hackney DB (2003) Diffusion-weighted MRI and the evaluation of spinal cord axonal integrity following injury and treatment. Exp Neurol 184:570–589PubMedCrossRefGoogle Scholar
  5. 5.
    Falconer JC, Narayana PA, Bhattacharjee MB, Liu SJ (1994) Quantitative MRI of spinal cord injury in a rat model. Magn Reson Med 32:484–491PubMedCrossRefGoogle Scholar
  6. 6.
    Ford JC, Hackney DB, Alsop DC et al (1994) MRI characterization of diffusion coefficients in a rat spinal cord injury model. Magn Reson Med 31:488–494PubMedCrossRefGoogle Scholar
  7. 7.
    Barzo P, Marmarou A, Fatouros P, Hayasaki K, Corwin F (1997) Contribution of vasogenic and cellular edema to traumatic brain swelling measured by diffusion-weighted imaging. J Neurosurg 87:900–907PubMedCrossRefGoogle Scholar
  8. 8.
    Liu AY, Maldjian JA, Bagley LJ, Sinson GP, Grossman RI (1999) Traumatic brain injury: diffusion-weighted MR imaging findings. AJNR Am J Neuroradiol 20:1636–1641PubMedGoogle Scholar
  9. 9.
    Clark CA, Barker GJ, Tofts PS (1999) Magnetic resonance diffusion imaging of the human cervical spinal cord in vivo. Magn Reson Med 41:1269–1273PubMedCrossRefGoogle Scholar
  10. 10.
    Bammer R, Augustin M, Prokesch RW, Stollberger R, Fazekas F (2002) Diffusion-weighted imaging of the spinal cord: interleaved echo-planar imaging is superior to fast spin-echo. J Magn Reson Imaging 15:364–373PubMedCrossRefGoogle Scholar
  11. 11.
    Plank C, Koller A, Mueller-Mang C, Bammer R, Thurnher MM (2007) Diffusion-weighted MR imaging (DWI) in the evaluation of epidural spinal lesions. Neuroradiology 49:977–985PubMedCrossRefGoogle Scholar
  12. 12.
    Zhang J, Huan Y, Qian Y, Sun L, Ge Y (2005) Multishot diffusion-weighted imaging features in spinal cord infarction. J Spinal Disord Tech 18:277–282PubMedGoogle Scholar
  13. 13.
    Zhang JSHY, Sun L (2007) Temporal evolution of spinal cord infarction in an in vivo experimental study of canine models characterized by diffusion-weighted imaging. J Magn Reson Imaging 26:848–854PubMedCrossRefGoogle Scholar
  14. 14.
    Ditunno JF Jr, Young W, Donovan WH, Creasey G (1994) The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia 32:70–80PubMedCrossRefGoogle Scholar
  15. 15.
    Tsuchiya K, Fujikawa A, Honya K, Tateishi H, Nitatori T (2006) Value of diffusion-weighted MR imaging in acute cervical cord injury as a predictor of outcome. Neuroradiology 48:803–808PubMedCrossRefGoogle Scholar
  16. 16.
    Pouw MH, van der Vliet AM, van Kampen A, Thurnher MM, van de Meent H, Hosman AJ (2012) Diffusion-weighted MR imaging within 24 h post-injury after traumatic spinal cord injury: a qualitative meta-analysis between T2-weighted imaging and diffusion-weighted MR imaging in 18 patients. Spinal Cord 50:426–431PubMedCrossRefGoogle Scholar
  17. 17.
    Shen H, Tang Y, Huang L et al (2007) Applications of diffusion-weighted MRI in thoracic spinal cord injury without radiographic abnormality. Int Orthop 31:375–383PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Lammertse D, Dungan D, Dreisbach J et al (2007) Neuroimaging in traumatic spinal cord injury: an evidence-based review for clinical practice and research. J Spinal Cord Med 30:205–214PubMedGoogle Scholar
  19. 19.
    Sagiuchi T, Tachibana S, Endo M, Hayakawa K (2002) Diffusion-weighted MRI of the cervical cord in acute spinal cord injury with type II odontoid fracture. J Comput Assist Tomogr 26:654–656PubMedCrossRefGoogle Scholar
  20. 20.
    Schwartz ED, Chin CL, Takahashi M, Hwang SN, Hackney DB (2002) Diffusion-weighted imaging of the spinal cord. Neuroimaging Clin N Am 12:125–146PubMedCrossRefGoogle Scholar
  21. 21.
    Tu TW, Kim JH, Wang J, Song SK (2010) Full tensor diffusion imaging is not required to assess the white-matter integrity in mouse contusion spinal cord injury. J Neurotrauma 27:253–262PubMedCrossRefGoogle Scholar
  22. 22.
    Yin B, Tang Y, Ye J et al (2010) Sensitivity and specificity of in vivo diffusion-weighted MRI in acute spinal cord injury. J Clin Neurosci 17:1173–1179PubMedCrossRefGoogle Scholar
  23. 23.
    Nevo U, Hauben E, Yoles E et al (2001) Diffusion anisotropy MRI for quantitative assessment of recovery in injured rat spinal cord. Magn Reson Med 45:1–9PubMedCrossRefGoogle Scholar
  24. 24.
    Tator CH, Fehlings MG (1991) Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 75:15–26PubMedCrossRefGoogle Scholar
  25. 25.
    Bammer R, Fazekas F (2003) Diffusion imaging of the human spinal cord and the vertebral column. Top Magn Reson Imaging 14:461–476PubMedCrossRefGoogle Scholar
  26. 26.
    Miyanji F, Furlan JC, Aarabi B, Arnold PM, Fehlings MG (2007) Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome–prospective study with 100 consecutive patients. Radiology 243:820–827PubMedCrossRefGoogle Scholar
  27. 27.
    Xing W, Wang X, Han Z, Liao W, Liu F (2010) Diffusion-weighted magnetic resonance imaging for acute trauma of the spine cord. Zhong Nan Da Xue Xue Bao Yi Xue Ban 35:760–765PubMedGoogle Scholar
  28. 28.
    Endo T, Suzuki S, Utsunomiya A, Uenohara H, Tominaga T (2011) Prediction of neurological recovery using apparent diffusion coefficient in cases of incomplete spinal cord injury. Neurosurgery 68:329–336PubMedCrossRefGoogle Scholar
  29. 29.
    Dorenbeck U, Schlaier J, Bretschneider T, Schuierer G, Feuerbach S (2005) Diffusion-weighted imaging with calculated apparent diffusion coefficient in intracranial hemorrhagic lesions. Clin Imaging 29:86–93PubMedCrossRefGoogle Scholar
  30. 30.
    Demir A, Ries M, Moonen CT et al (2003) Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy. Radiology 229:37–43PubMedCrossRefGoogle Scholar
  31. 31.
    Ries M, Jones RA, Dousset V, Moonen CT (2000) Diffusion tensor MRI of the spinal cord. Magn Reson Med 44:884–892PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  1. 1.Department of Radiology, Xijing HospitalFourth Military Medical UniversityXi’anPeople’s Republic of China

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