Spinal Cord Myelopathies: Overview, Imaging Approach, and Differential Diagnosis-Part 2

Myelopathy encompasses a heterogeneous group of spinal cord disorders with diverse etiologies, clinical presentations, and management implications. This section reviews intrinsic, noncompressive causes, including demyelinating, inflammatory, vascular, infectious, metabolic, toxic, and neoplastic processes. These entities frequently affect younger patients or present with acute or subacute neurologic decline and often demonstrate overlapping MR imaging features. Pattern-based interpretation incorporating lesion length, axial distribution, cord expansion, diffusion restriction, and enhancement characteristics is central to narrowing the differential diagnosis. Integration of imaging findings with clinical context, laboratory evaluation, and follow-up imaging is critical to ensure diagnostic accuracy and avoid delays in therapy.