Marofe Hossain, Sun Hao, Ahamed Yeasin, Yongxiang Wang
{"title":"Development and validation of an MRI-Based nomogram for predicting neurological recovery after acute cervical spinal cord injury.","authors":"Marofe Hossain, Sun Hao, Ahamed Yeasin, Yongxiang Wang","doi":"10.1038/s41393-026-01210-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>Acute cervical spinal cord injury (CSCI) leads to severe and variable neurological outcomes. Early, accurate prognosis is crucial for clinical decisions and patient counseling. This study aimed to identify key prognostic factors and develop a reliable, imaging-based nomogram for predicting neurological recovery after surgical treatment.</p><p><strong>Setting: </strong>Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China.</p><p><strong>Methods: </strong>In a retrospective cohort of 103 surgically treated acute traumatic CSCI patients, neurological recovery was defined as ≥1 grade improvement on the ASIA Impairment Scale at 6 months. We analyzed clinical variables and MRI parameters: intramedullary edema length (IEL), intramedullary hemorrhage length (IHL), and maximum spinal cord compression (MSCC). Independent predictors were identified via multivariate logistic regression. A nomogram was built and internally validated using the C-index, calibration curves, ROC analysis, and DCA.</p><p><strong>Results: </strong>Neurological recovery occurred in 73 patients (70.9%). Multivariate analysis identified IEL (OR = 0.904), IHL (OR = 0.808), and MSCC (OR = 0.812) as independent predictors (all p < 0.05). IEL showed a threshold effect at 48 mm, beyond which recovery probability declined markedly. The nomogram demonstrated excellent predictive performance, with C-indices of 0.969 (modeling) and 0.936 (validation). ROC and DCA confirmed its superior accuracy and clinical utility over single parameters.</p><p><strong>Conclusions: </strong>IEL, IHL, and MSCC are key imaging-based predictors of recovery after acute CSCI. The developed nomogram provides an accurate, practical tool for individualized prognosis, supporting precision clinical management. MRI-based parameters including intramedullary edema length (IEL), intramedullary hemorrhage length (IHL), and maximum spinal cord compression (MSCC) were integrated into a nomogram model to predict neurological recovery in patients with acute cervical spinal cord injury.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spinal cord","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41393-026-01210-4","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Study design: Retrospective cohort study.
Objectives: Acute cervical spinal cord injury (CSCI) leads to severe and variable neurological outcomes. Early, accurate prognosis is crucial for clinical decisions and patient counseling. This study aimed to identify key prognostic factors and develop a reliable, imaging-based nomogram for predicting neurological recovery after surgical treatment.
Methods: In a retrospective cohort of 103 surgically treated acute traumatic CSCI patients, neurological recovery was defined as ≥1 grade improvement on the ASIA Impairment Scale at 6 months. We analyzed clinical variables and MRI parameters: intramedullary edema length (IEL), intramedullary hemorrhage length (IHL), and maximum spinal cord compression (MSCC). Independent predictors were identified via multivariate logistic regression. A nomogram was built and internally validated using the C-index, calibration curves, ROC analysis, and DCA.
Results: Neurological recovery occurred in 73 patients (70.9%). Multivariate analysis identified IEL (OR = 0.904), IHL (OR = 0.808), and MSCC (OR = 0.812) as independent predictors (all p < 0.05). IEL showed a threshold effect at 48 mm, beyond which recovery probability declined markedly. The nomogram demonstrated excellent predictive performance, with C-indices of 0.969 (modeling) and 0.936 (validation). ROC and DCA confirmed its superior accuracy and clinical utility over single parameters.
Conclusions: IEL, IHL, and MSCC are key imaging-based predictors of recovery after acute CSCI. The developed nomogram provides an accurate, practical tool for individualized prognosis, supporting precision clinical management. MRI-based parameters including intramedullary edema length (IEL), intramedullary hemorrhage length (IHL), and maximum spinal cord compression (MSCC) were integrated into a nomogram model to predict neurological recovery in patients with acute cervical spinal cord injury.
期刊介绍：
Spinal Cord is a specialised, international journal that has been publishing spinal cord related manuscripts since 1963. It appears monthly, online and in print, and accepts contributions on spinal cord anatomy, physiology, management of injury and disease, and the quality of life and life circumstances of people with a spinal cord injury. Spinal Cord is multi-disciplinary and publishes contributions across the entire spectrum of research ranging from basic science to applied clinical research. It focuses on high quality original research, systematic reviews and narrative reviews.
Spinal Cord''s sister journal Spinal Cord Series and Cases: Clinical Management in Spinal Cord Disorders publishes high quality case reports, small case series, pilot and retrospective studies perspectives, Pulse survey articles, Point-couterpoint articles, correspondences and book reviews. It specialises in material that addresses all aspects of life for persons with spinal cord injuries or disorders. For more information, please see the aims and scope of Spinal Cord Series and Cases.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
