Cervical myelitis: a practical approach to its differential diagnosis on MR imaging

Area of Science:

• Neurology
• Neuroradiology
• Immunology

Background:

• Non-compressive cervical myelopathy presents diverse causes including inflammatory, infectious, vascular, neoplastic, neurodegenerative, and metabolic conditions.
• While symptom onset and clinical course offer clues, Magnetic Resonance (MR) imaging lesion patterns are critical for confirming diagnostic considerations in cervical myelopathy.

Purpose of the Study:

• To elucidate the diagnostic utility of specific medullary MRI lesion patterns in differentiating various causes of non-compressive cervical myelopathy.
• To emphasize the importance of integrating imaging findings with clinical and laboratory data for accurate diagnosis.

Main Methods:

• Analysis of typical medullary MRI lesion patterns, including longitudinal extensive transverse myelitis, short-range ovoid/peripheral lesions, polio-like appearance, and granulomatous nodular enhancement.
• Differentiation between acute complete and acute partial transverse myelitis.
• Integration of neuroradiological findings with cerebrospinal fluid (CSF) analysis, blood cultures, and autoimmune antibody testing.

Main Results:

• Distinct medullary MRI lesion patterns (longitudinal extensive transverse, short ovoid/peripheral, polio-like, granulomatous nodular) aid in diagnosing myelitis.
• Distinguishing acute complete from acute partial transverse myelitis helps identify entities such as multiple sclerosis (MS).
• Neuromyelitis optica spectrum disorders (NMOSD) can manifest as short transverse myelitis, distinct from MS.

Conclusions:

• Combining specific MRI lesion patterns with neurological examinations and laboratory findings, including CSF analysis, significantly enhances diagnostic accuracy for cervical myelopathy.
• Brain imaging is essential for suspected demyelinating, autoimmune, infectious, paraneoplastic, and metabolic diseases.
• Accurate differentiation of myelitis types and associated imaging patterns is crucial for appropriate patient management and distinguishing conditions like MS and NMOSD.