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Updated: Aug 14, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Acute partial transverse myelitis with normal cerebral magnetic resonance imaging: transition rate to clinically
Thomas F Scott1, Salima L Kassab, Shalu Singh
1Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA. tscott@wpahs.org
Objective:
To determine the long-term risk of developing clinically definite multiple sclerosis (CDMS) in patients with acute partial transverse myelitis (APTM) and normal cerebral magnetic resonance imaging (MRI) scans.
Methods:
We retrospectively studied 30 consecutive patients with clinical evidence of APTM. Patients with symmetric severe acute transverse myelitis were considered to have complete transverse myelitis and were excluded. All patients underwent spinal and cerebral MRIs, 13 underwent cerebrospinal fluid analysis and 11 patients underwent evoked potential studies. Various other studies were performed to assess for connective tissue disease and causes of APTM other than demyelinating disease.
Results:
After an average follow-up of 61 months, all laboratory and clinical evidence, including relapse history, indicated that three patients developed lesions on cerebral MRI and could be classified as CDMS by either Poser criteria (two patients) or MacDonald criteria (one patient). Relapses limited to the spinal cord seen clinically were seen in 14/30 (46.6%) patients. Oligoclonal bands were seen in 8/13 (62%) patients; one patient transitioned to CDMS. Unifocal lesions of the cord were seen in 19/30 (63%) patients, multifocal lesions were seen in 8/30 (27%) and 3/30 (10%) had negative MRIs. The three patients who converted to CDMS did so within five years of the onset of myelitis.
Conclusion:
APTM with normal cerebral MRI had a low rate of conversion to CDMS in this long-term study. To date, there have been only a few follow-up studies that have addressed this issue.
Insights
Patients with acute partial transverse myelitis (APTM) and normal brain MRI scans have a low risk of developing clinically definite multiple sclerosis (CDMS). Most conversions to CDMS occurred within five years of initial myelitis symptoms.
Area of Science:
- Neurology
- Neuroimmunology
- Clinical Neuroscience
Background:
- Acute partial transverse myelitis (APTM) is an inflammatory condition affecting the spinal cord.
- The risk of progression to multiple sclerosis (MS) in APTM patients with normal initial cerebral MRI is not well-established.
- Differentiating APTM from early MS is crucial for prognosis and management.
Purpose of the Study:
- To investigate the long-term risk of developing clinically definite multiple sclerosis (CDMS) in patients diagnosed with APTM and unremarkable cerebral MRI scans.
- To identify predictors of conversion from APTM to CDMS.
Main Methods:
- Retrospective study of 30 consecutive APTM patients with normal cerebral MRI at presentation.
- Exclusion of patients with complete transverse myelitis.
- Follow-up included clinical assessment, relapse history, spinal and cerebral MRI, cerebrospinal fluid analysis, evoked potential studies, and tests for connective tissue disease.
Main Results:
- Over a mean follow-up of 61 months, 3 out of 30 patients developed CDMS (Poser or MacDonald criteria).
- 14.6% of patients experienced relapses limited to the spinal cord.
- Oligoclonal bands were present in 62% of CSF samples; one patient with oligoclonal bands converted to CDMS.
- Conversion to CDMS occurred within five years of APTM onset.
Conclusions:
- APTM with normal initial cerebral MRI demonstrates a low long-term risk of conversion to CDMS.
- The majority of CDMS conversions occurred within the first five years post-APTM.
- Further long-term follow-up studies are warranted to fully elucidate the risk profile.
