MRI Evaluation of Spinal Hematomas

Imaging Recommendations for Spinal Hematomas

• The American College of Radiology (ACR) recommends MRI without contrast as the preferred imaging modality for evaluating hematomas near the spine, as contrast administration is not necessary for this specific indication 1, 2
• According to the American College of Radiology (ACR) Appropriateness Criteria, there is no relevant literature to support the use of MRI spine area of interest with IV contrast in the evaluation of spinal trauma, which includes hematomas 1, 2
• MRI without contrast is valuable for guiding surgical interventions by displaying cord compression caused by hematomas 1

Clinical Implications

• For patients with suspected spinal cord injury, MRI characterizes the cause and extent of injuries from hematomas and other pathologies 1
• Diffusion-weighted imaging should be included in MRI protocols when spinal cord ischemia is a concern, as it can show signal alteration earlier than T2-weighted images 3, 4

Important Caveats

• The American College of Radiology (ACR) indicates that contrast-enhanced MRI is not necessary for the evaluation of traumatic hematomas, but may be considered in the follow-up phase if there is concern for an underlying vascular malformation or tumor causing the hematoma 1, 2, 3, 4