Imaging characteristics of cervical spine extra-arachnoid fluid collections managed conservatively

David A. Lawrence, Brian Trotta, Francis H. Shen, Jason T. Druzgal, Michael Fox

Research output: Contribution to journalArticle

Abstract

Objective: Determine the MRI characteristics of large post-traumatic cervical spine extra-arachnoid collections managed conservatively in clinically stable patients and whether evidence of clinical or imaging deterioration materialized. Materials and methods: Following IRB approval, we conducted a retrospective search for all patients (>16 years old) over a 17-months period who had an extra-arachnoid fluid collection reported on a post-traumatic cervical spine MRI. Patients were excluded if they had surgery for an unstable fracture (n = 21), emergent decompression (n = 1) or lacked a follow-up MRI within 15 days (n = 1). Two MSK radiologists recorded the size, morphology and MRI signal characteristics of the collections. Results: Eight patients (5 male, 3 female) met the inclusion criteria (mean age 40 years; range 19–78 years). Seven of the eight patients had fluid collections that demonstrated thin, tapered margins, extended >7 vertebral bodies and involved >180 degrees of the spinal canal. The signal characteristics of these collections varied: hyper-T1/iso-T2 (n = 1), iso-T1/T2 (n = 3), hyper-T1/hypo-T2 (n = 3) and mixed-T1/T2 (n = 1). Six of seven collections were ventral. Follow-up MRI demonstrated resolution/significant decrease in size (n = 4 between 1 and 12 days) or no change/slight decrease in size (n = 3; between 2 and 11 days). None of the seven fluid collections enlarged, no patient had abnormal cord signal, and no patient’s neurologic symptoms worsened. One of eight patients had a dorsal “mass-like” collection that was slightly smaller 9 days later. Conclusion: In stable patients with large, tapered post-traumatic cervical spine extra-arachnoid collections managed non-surgically, none developed (1) clinical worsening, (2) abnormal cord signal or (3) collection enlargement, regardless of the collection’s signal characteristics.

Original languageEnglish (US)
Pages (from-to)1285-1289
Number of pages5
JournalSkeletal Radiology
Volume45
Issue number9
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

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Arachnoid
Spine
Spinal Canal
Research Ethics Committees
Neurologic Manifestations
Decompression

Keywords

  • Cervical spine
  • Epidural hematoma
  • Magnetic resonance imaging
  • Trauma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Imaging characteristics of cervical spine extra-arachnoid fluid collections managed conservatively. / Lawrence, David A.; Trotta, Brian; Shen, Francis H.; Druzgal, Jason T.; Fox, Michael.

In: Skeletal Radiology, Vol. 45, No. 9, 01.09.2016, p. 1285-1289.

Research output: Contribution to journalArticle

Lawrence, David A. ; Trotta, Brian ; Shen, Francis H. ; Druzgal, Jason T. ; Fox, Michael. / Imaging characteristics of cervical spine extra-arachnoid fluid collections managed conservatively. In: Skeletal Radiology. 2016 ; Vol. 45, No. 9. pp. 1285-1289.
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abstract = "Objective: Determine the MRI characteristics of large post-traumatic cervical spine extra-arachnoid collections managed conservatively in clinically stable patients and whether evidence of clinical or imaging deterioration materialized. Materials and methods: Following IRB approval, we conducted a retrospective search for all patients (>16 years old) over a 17-months period who had an extra-arachnoid fluid collection reported on a post-traumatic cervical spine MRI. Patients were excluded if they had surgery for an unstable fracture (n = 21), emergent decompression (n = 1) or lacked a follow-up MRI within 15 days (n = 1). Two MSK radiologists recorded the size, morphology and MRI signal characteristics of the collections. Results: Eight patients (5 male, 3 female) met the inclusion criteria (mean age 40 years; range 19–78 years). Seven of the eight patients had fluid collections that demonstrated thin, tapered margins, extended >7 vertebral bodies and involved >180 degrees of the spinal canal. The signal characteristics of these collections varied: hyper-T1/iso-T2 (n = 1), iso-T1/T2 (n = 3), hyper-T1/hypo-T2 (n = 3) and mixed-T1/T2 (n = 1). Six of seven collections were ventral. Follow-up MRI demonstrated resolution/significant decrease in size (n = 4 between 1 and 12 days) or no change/slight decrease in size (n = 3; between 2 and 11 days). None of the seven fluid collections enlarged, no patient had abnormal cord signal, and no patient’s neurologic symptoms worsened. One of eight patients had a dorsal “mass-like” collection that was slightly smaller 9 days later. Conclusion: In stable patients with large, tapered post-traumatic cervical spine extra-arachnoid collections managed non-surgically, none developed (1) clinical worsening, (2) abnormal cord signal or (3) collection enlargement, regardless of the collection’s signal characteristics.",
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