The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings

Jason F. Talbott Departments of Radiology and Biomedical Imaging,
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California

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 MD, PhD
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William D. Whetstone Department of Emergency Medicine and

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William J. Readdy Neurological Surgery, and

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Adam R. Ferguson Neurological Surgery, and
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California

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Jacqueline C. Bresnahan Neurological Surgery, and
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California

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Rajiv Saigal Neurological Surgery, and
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California

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Gregory W. J. Hawryluk Neurological Surgery, and
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California

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Michael S. Beattie Neurological Surgery, and
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California

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Marc C. Mabray Departments of Radiology and Biomedical Imaging,

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Jonathan Z. Pan Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
Anesthesia and Perioperative Care, University of California; and

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Geoffrey T. Manley Neurological Surgery, and
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California

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Sanjay S. Dhall Neurological Surgery, and
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California

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OBJECT

Previous studies that have evaluated the prognostic value of abnormal changes in signals on T2-weighted MRI scans of an injured spinal cord have focused on the longitudinal extent of this signal abnormality in the sagittal plane. Although the transverse extent of injury and the degree of spared spinal cord white matter have been shown to be important for predicting outcomes in preclinical animal models of spinal cord injury (SCI), surprisingly little is known about the prognostic value of altered T2 relaxivity in humans in the axial plane.

METHODS

The authors undertook a retrospective chart review of 60 patients who met the inclusion criteria of this study and presented to the authors’ Level I trauma center with an acute blunt traumatic cervical SCI. Within 48 hours of admission, all patients underwent MRI examination, which included axial and sagittal T2 images. Neurological symptoms, evaluated with the grades according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS), at the time of admission and at hospital discharge were correlated with MRI findings. Five distinct patterns of intramedullary spinal cord T2 signal abnormality were defined in the axial plane at the injury epicenter. These patterns were assigned ordinal values ranging from 0 to 4, referred to as the Brain and Spinal Injury Center (BASIC) scores, which encompassed the spectrum of SCI severity.

RESULTS

The BASIC score strongly correlated with neurological symptoms at the time of both hospital admission and discharge. It also distinguished patients initially presenting with complete injury who improved by at least one AIS grade by the time of discharge from those whose injury did not improve. The authors’ proposed score was rapid to apply and showed excellent interrater reliability.

CONCLUSIONS

The authors describe a novel 5-point ordinal MRI score for classifying acute SCIs on the basis of axial T2-weighted imaging. The proposed BASIC score stratifies the SCIs according to the extent of transverse T2 signal abnormality during the acute phase of the injury. The new score improves on current MRI-based prognostic descriptions for SCI by reflecting functionally and anatomically significant patterns of intramedullary T2 signal abnormality in the axial plane.

ABBREVIATIONS

AIS = American Spinal Injury Association (ASIA) Impairment Scale; BASIC = Brain and Spinal Injury Center; PACS = picture archiving and communication system; SCI = spinal cord injury.
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