Magnetic resonance imaging findings in 22 cases of myelitis: comparison between patients with and without multiple sclerosis

• Published in: European journal of neurology Vol. 5; no. 1; pp. 35 - 48
• Main Authors: Bakshi, R., Kinkel, P.R., Mechtler, L.L., Bates, V.E., Lindsay, B.D., Esposito, S.E., Kinkel, W.R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-01-1998
• Subjects: magnetic resonance imaging; multiple sclerosis; myelopathy; spinal cord; transverse myelitis
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1046/j.1468-1331.1998.510035.x

We reviewed the magnetic resonance imaging (MRI) database of the Dent Neurologic Institute to study the abnormal findings in myelitis. We identified 22 patients, and compared non‐MS‐related acute transverse myelitis (ATM, n= 9), to myelitis associated with multiple sclerosis (MS‐myelitis, n= 13). The ATM patients were significantly older than MS patients at the time of the myelitis diagnosis (mean age 46 vs 35, p < 0.05). ATM appeared as a “longitudinal myelitis”, with fusiform cord expansion on T1‐weighted images and intramedullary increased signal on T2‐weighted images, each involving multiple spinal levels (mean = 7–8). However, MS‐myelitis lesions appeared focal, involving significantly fewer spinal levels (mean = 1–2, p < 0.001), although the lesions were equally likely to expand the cord. Four (42%) of the ATM lesions showed abnormal, variable enhancement, whereas none of the MS myelitis lesions enhanced. Cranial MRI was more likely to be normal in ATM (78%) than in MS‐myelitis patients (15%, p < 0.001). Although readily distinguishable from lesions due to MS, the various etiologies for ATM, including post‐infectious (n= 2), post‐vaccination (n= 3), and idiopathic (n= 4) were indistinguishable on MRI. The MRI findings of an extensively lesioned, swollen cord, suspicious for an intramedullary tumor and providing a temptation for a biopsy, may reflect a non‐neoplastic inflammatory disorder.