Radiological approach to non-compressive myelopathies

Abstract

Background Myelopathy, a pathological condition related to the spinal cord can broadly be categorized into compressive and non-compressive aetiologies. Magnetic resonance imaging remains the modality of choice when suspecting non-compressive myelopathy as it helps to localize the affected segment and exclude compression as the cause of myelopathy. This review deals with the imaging approach for non-compressive myelopathies. Main body Demyelinating disorders are the most common cause of non-compressive myelopathy and often show confounding features. Other causes include inflammatory, ischemic, metabolic, and neoplastic disorders. Non-compressive myelopathy can broadly be classified into acute and non-acute onset which can further be categorized according to the distribution of the signal abnormalities, including length of cord involvement, specific tract involvement, enhancement pattern, and the region of the spinal cord that is affected. Conclusions Imaging plays a critical role in the evaluation of clinically suspected cases of myelopathy and MR imaging (with or without contrast) remains the preferred modality. Compressive causes must be excluded as a cause of myelopathy. Despite a multitude of causes, the most common imaging appearance is a nonspecific T2 hyperintense signal in the spinal cord, and thus, a pragmatic diagnostic approach along with appropriate clinical and biochemical correlation is essential for arriving at an accurate diagnosis.

Nontraumatic Spine Emergencies: A Primer for the On-Call Radiologist

“…Imaging features include mild diffuse cauda equina nerve root thickening with clumping of nerve roots and hyperenhancement with a predilection for ventral root. 12 Imaging differentials are leptomeningeal carcinomatosis 13 and chronic polyneuropathies such as chronic inflammatory demyelinating polyneuropathy 14 and hereditary polyneuropathies, 15 which have a more subacute to chronic timeline. Miller-Fisher syndrome is a variant of GBS, which presents with a triad of ophthalmoplegia, ataxia, and areflexia.…”

“…The imaging differential includes multiple sclerosis, which will have more peripheral lesions, and venous hypertension, which will be seen in the setting of other vascular etiologies such as arteriovenous fistula (AVF) or arteriovenous malformation (AVM). 12…”

“…CSF findings include mild pleocytosis or protein elevation and albuminocytologic dissociation (elevation of CSF protein without pleocytosis). Imaging features include mild diffuse cauda equina nerve root thickening with clumping of nerve roots and hyperenhancement with a predilection for ventral root 12. Imaging differentials are leptomeningeal carcinomatosis13 and chronic polyneuropathies such as chronic inflammatory demyelinating polyneuropathy14 and hereditary polyneuropathies,15 which have a more subacute to chronic timeline.…”

Nontraumatic Spine Emergencies: A Primer for the On-Call Radiologist

“…Imaging features include mild diffuse cauda equina nerve root thickening with clumping of nerve roots and hyperenhancement with a predilection for ventral root. 12 Imaging differentials are leptomeningeal carcinomatosis 13 and chronic polyneuropathies such as chronic inflammatory demyelinating polyneuropathy 14 and hereditary polyneuropathies, 15 which have a more subacute to chronic timeline. Miller-Fisher syndrome is a variant of GBS, which presents with a triad of ophthalmoplegia, ataxia, and areflexia.…”

“…The imaging differential includes multiple sclerosis, which will have more peripheral lesions, and venous hypertension, which will be seen in the setting of other vascular etiologies such as arteriovenous fistula (AVF) or arteriovenous malformation (AVM). 12…”