Related Experiment Video
Updated: Mar 14, 2026
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Specific MRI findings help distinguish acute transverse myelitis of Neuromyelitis Optica from spinal cord infarction
1NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, New York University School of Medicine, New York, NY, USA.
Background:
There is substantial overlap between MRI of acute spinal cord lesions from neuromyelitis optica (NMO) and spinal cord infarct (SCI) in clinical practice. However, early differentiation is important since management approaches to minimize morbidity from NMO or SCI differ significantly.
Objective:
To identify MRI features at initial presentation that may help to differentiate NMO acute myelitis from SCI.
Methods:
2 board-certified neuroradiologists, blinded to final diagnosis, retrospectively characterized MRI features at symptom onset for subjects with serologically-proven NMO (N=13) or SCI (N=11) from a single institution. Univariate and multivariate analyses were used to identify factors associated with NMO or SCI.
Results:
SCI was more common in men and Caucasians, while NMO was more common in non-Caucasian women (P<0.05). MRI features associated with NMO acute myelitis (P<0.05) included location within 7-cm of cervicomedullary junction; lesion extending to pial surface; 'bright spotty lesions' on axial T2 MRI; and gadolinium enhancement. Patient's age, lesion length and cross-sectional area, cord expansion, and the "owl's eyes" sign did not differ between the two groups (P>0.05).
Conclusion:
Along with patient demographic characteristics, lesion features on MRI, including lesion location, extension to pial border and presence of 'bright spotty lesion' can help differentiate acute myelitis of NMO from SCI in the acute setting.
Insights
Differentiating acute spinal cord lesions from neuromyelitis optica (NMO) and spinal cord infarct (SCI) is crucial for patient management. MRI features like lesion location and "bright spotty lesions" aid in early diagnosis.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Neuromyelitis optica (NMO) and spinal cord infarct (SCI) present overlapping MRI findings.
- Early differentiation is critical due to distinct management strategies for NMO and SCI.
Purpose of the Study:
- To identify specific MRI characteristics that distinguish acute NMO myelitis from SCI at initial presentation.
Main Methods:
- Retrospective analysis of MRI scans from patients with serologically-proven NMO (N=13) or SCI (N=11).
- Two blinded neuroradiologists characterized MRI features at symptom onset.
- Univariate and multivariate analyses identified differentiating factors.
Main Results:
- NMO was more prevalent in non-Caucasian women; SCI in men and Caucasians.
- MRI features associated with NMO included lesions near the cervicomedullary junction, extension to the pial surface, 'bright spotty lesions' on axial T2 MRI, and gadolinium enhancement.
- No significant differences were observed in patient age, lesion size, cord expansion, or the 'owl's eyes' sign.
Conclusions:
- Demographic data combined with specific MRI findings can differentiate acute NMO myelitis from SCI.
- Key differentiating MRI features include lesion location, pial border extension, and the presence of 'bright spotty lesions'.
