Background: When intramedullary high-intensity lesions are found on cervical T2-weighted magnetic resonance images of patients with whiplash injury, it is often required to identify whether they are due to spinal cord injury (SCI) or cervical compressive myelopathy (CCM). This is important to determine insurance coverage. Thus, this study aimed to develop a method to distinguish between SCI and CCM.
Methods: Magnetic resonance images of 20 patients who had cervical SCI were evaluated. These 20 SCI patients were age- and sex-matched to 20 CCM patients. The number of discs adjacent to T2 high-intensity lesions was counted because the T2 high-intensity lesions in SCI were characterized by sagittal dilation. The “snake-eyes appearance” was assessed as a characteristic finding of CCM. T2 values in T2 high-intensity lesions were evaluated quantitatively by its ratio with the T2 values in the normal spinal cord, including signal ratio and contrast ratio.
Results: The number of discs adjacent to T2 high-intensity lesions was significantly higher in SCI than in CCM. The snake-eyes appearance was found in 9 of 20 CCM patients, but not in SCI patients. The signal ratio and contrast ratio on axial images were significantly higher in SCI than in CCM. A new diagnostic scale was created based on these results. This diagnostic scale has made it possible to distinguish SCI and CCM with >90% accuracy from all perspectives including sensitivity, specificity, positive predictive value, and negative predictive value.
Conclusions: The features of T2 high-intensity lesions can be used to distinguish between SCI and CCM.