Inversion recovery versus T2-weighted sagittal MR imaging in cervical spinal cord injury

Purpose: To determine the usefulness of the fluid-attenuation inversion-recovery (FLAIR) sequence in the detection of cervical spinal cord contusion following blunt trauma, as compared with the conventional T2-weighted (T2W) MR sequence. Methods: Three radiologists independently reviewed T2W and FLAIR sagittal MR images in 25 patients with acute cord contusion. Conspicuity of cord contusion was rated on a scale of 0 (no evidence of contusion) to 3 (contusion easily identified). The average ratings for the T2W sequence and FLAIR sequence were then compared. Images were also reviewed in consensus for evidence of hemorrhage and extent of cord edema. Results: Twenty-three patients had increased conspicuity of cord contusion on the FLAIR sequence as compared with the T2W sequence, while two patients demonstrated no change in conspicuity. T2W images had an average rating of 1.0, while FLAIR images had an average rating of 2.2. The extent of edema was better evaluated in 17 patients with the FLAIR sequence and in 8 patients with the T2W sequence. Hemorrhagic contusion was seen in 15 patients, better identified with T2W sequence in 9 patients and with FLAIR sequence in only 2 patients. Conclusion: Cervical spinal cord contusion is much more conspicuous on FLAIR sequence as compared with T2W sequence. Additionally, FLAIR imaging can often demonstrate the true extent of edema better than T2W imaging. However, hemorrhage within contusion, an important prognostic factor, is better demonstrated with T2W imaging. Therefore, both sequences should be utilized in order to maximize both the identification and characterization of acute spinal cord contusion.