This is Barry Bellosis, one of the musculoskeletal radiology fellows at Stanford University. 23 year old male special teams football player complains of bilateral stingers, concern for spinal cord contusion. The patient in this case presented with this MRI without contrast. In here, on our sagittal T2 fat set imaging, we can see some focal enlargement with intrinsic T2 signal of the spinal cord, consistent with spinal cord edema. On our sagittal T2 imaging, again, we can see this increased signal within the spinal cord, which correlates to finding in our T2 fat set imaging, consistent with spinal cord edema. On a different patient, a college football player with acute paraplegia, with concern for spinal cord contusion, spinal cord contusion is defined as a central intramedullary focus of low signal in the cord surrounded by a thick rim of hyperintensity on T2 weighted imaging. So on this patient, we have a sagittal T1 imaging, we can see a slight focal enlargement of the spinal cord and at the level of C2, we can see this focus of hypointensity. On our sagittal T2 imaging, we can again see that T2 hypointensity at C2 and also at C3 with surrounding T2 hyperintensity. These findings are consistent with spinal cord contusion. We can also see this focal enlargement of the cord at this level. Gradient echo sequences should be used as the regular sequences that we use may underestimate the degree of hematoma. Here is the MRI without contrast using T2 gradient echo sequence. Here at the level of C2, we can see this focus of blooming artifact in the intramedullary spinal cord and as we go down, we can see this again blooming artifact here and also here. All these findings are consistent with hematoma or hemorrhage in the intramedullary spinal cord which is associated with spinal cord contusion.

2nd Edition, CASE 52

2nd Edition

Spine

MRI findings

spinal cord edema

spinal cord contusion

gradient echo sequences

hematoma detection