Association between swallowing disorder and prevertebral hyperintensity on magnetic resonance imaging in patients after cervical cord injury without major fracture

Abstract

This study aimed to clarify the association between swallowing disorder and prevertebral hyperintensity on magnetic resonance imaging (MRI) in patients with cervical spinal cord injury (CSCI) without a major fracture. This retrospective observational study included 30 patients who were diagnosed with acute CSCI without a major fracture (mean age: 69.3 years, 27 men). Swallowing disorder was defined as tube-dependent nutrition because of obvious aspiration 28 days after injury. The high-intensity area (HIA) and anteroposterior width (HIW) of the prevertebral space at C1–7 levels were measured using MRI short-TI inversion recovery midsagittal images. Receiver operating characteristic curve analysis was used to determine the optimal cutoff values of the HIA for predicting swallowing disorder. The incidence of swallowing disorder after CSCI was 16.7%. The HIA was significantly higher in the swallowing disorder group (median, 409.0 mm2) than in the non- swallowing disorder group (median, 159.1 mm2) (P = .04). There was no significant difference in HIW between the two groups. The optimal cutoff point of the HIA was measured at 203.2 mm2 with 80.0% and 20.0% sensitivity and specificity, respectively, with an area under the curve of 0.848 (95% confidence interval, 0.657–1.000, P = .01). The prevertebral hyperintensity area on MRI for swallowing disorder in patients after cervical cord injury without skeletal injury is associated with swallowing disorder. The optimal cutoff point of the area was determined to be 203.2 mm2.