MR imaging of compressive myelomalacia

The authors studied retrospectively 42 patients with the magnetic resonance (MR) diagnosis of myelomalacia. Depending on MR findings, the patients were grouped into early, intermediate, and late stages of myelomalacia. Early stage myelomalacia patients presented with high intensity signal changes on T2-weighted images involving the width of the affected cord. The intermediate stage patients were characterized by varying degrees of cystic necrosis of the central gray matter, better seen on T2-weighted images. Central cystic degeneration, syrinx formation, and atrophy were prominent features of the late stage of myelomalacia. Ten patients had follow-up MR examinations within 6 months of initial imaging. Two of the four early stage myelomalacia patients showed improvement in the repeat studies. The follow-up scans of the six intermediate and late stage myelomalacia patients showed either no change or progression of disease. Early stage myelomalacia may be reversible, depending on the severity of the initial spinal cord injury. Magnetic resonance can serve as a useful tool in the assessment and management of myelomalacia patients.