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Emergency Radiology

E2754. Is This Really SCIWORA? Spectrum of Imaging Findings in the Clinicoradiologic Entity

Rangarajan K,  Kumar A,  Gamanagatti S,  Kumar P,  Sinha S. All India Institute of Medical Sciences,, New Delhi, India

Address correspondence to K. Rangarajan (krithikarangarajan86@gmail.com)

Background Information: The term, “SCIWORA” (spinal cord injury without radiographic abnormality) was coined in before the MRI era to explain the occurrence of neurologic deficits in spinal trauma in the absence of spinal fractures. With the advent of MRI, the term and classification has undergone significant changes, with some authors introducing the differentiation between SCIWORA and the “real” SCIWORA, for which others have suggested a new term, “SCIWNA” (spinal cord abnormalities without neuroimaging abnormality). In addition, the occurrence of SCIWORA in a background of degenerative changes has led to the coining of yet another term, “SCIWORNET” (spinal cord injury without neuroimaging evidence of trauma. The purpose of this exhibit is to identify and define all abnormalities that would fit under the umbrella of SCIWORA, present the imaging spectrum, and define use of appropriate terms in relation to SCIWORA.

Educational Goals/Teaching Points: This exhibit focuses on when to suspect SCIWORA and when to perform MRI, with a review of spine biomechanics and pathophysiology of SCIWORA. We will review the MRI protocol (what to look for in which sequence) and the spectrum of imaging abnormalities in SCIWORA. We also review appropriate terminology: SCIWORA, “real” SCIWORA, SCIWNA, and SCIWNET. Lastly, we discuss MRI in prognosis of SCIWORA.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: This exhibit reviews the clinical evaluation and when to suspect SCIWORA, including pathophysiology and biomechanics of the spine, MR pulse sequences, and utility of various sequences. We review imaging findings to show the spectrum of intrinsic spinal cord abnormalities in SCIWORA including normal MR images, cord edema, cord contusions, and complete cord transection. We also review the spectrum of ligamentous and disc-related injuries in SCIWORA including disc degeneration and spinal cord compression. Lastly, we review appropriate use of terms and prognosis.

Conclusion: The terminology and knowledge in SCIWORA has evolved and grown with the capability of imaging to identify abnormalities in SCIWORA. Although gaps in our knowledge in this clinical-radiologic mismatch have been bridged, newer terms have emerged. It is important for the radiologist to be aware of the entity and use appropriate terms to convey important imaging findings that would determine the prognosis.