Imaging

Transverse Myelitis

Preliminary Diagnosis: Transverse myelitis

I. What imaging technique is first-line for this diagnosis

  • MR imaging with IV contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of transverse myelitis.

Advantages

  • Diagnostic with positive pertinent findings: central cord lesion >2 vertebral body segments +/- patchy enhancement.

  • Able to locate the level of infection and inflammation and predict any neurological (sensory, motor) and specifically dermatomal abnormalities.

  • Able to rule out any secondary complications from a primary infectious or inflammatory transverse myelitis: such as discitis, osteomyelitis, or epidural abscess.

  • Does not use ionizing radiation.

Disadvantages

  • Expensive

  • Time-consuming imaging modality

  • Requires significant patient cooperation to limit motion artifact.

  • 40-50% of cases of transverse myelitis are not demonstrated by MR.

III. What are the contraindications for the first-line imaging technique?

  • Contraindicated in patients with non-MR compatible hardware and noncompatible foreign bodies.

  • MR imaging with intravenous contrast requires that the patient have good renal function with GFR greater than 60. Administration of intravenous contrast is decided individually on a case-by-case basis with GFR < 60 and >30.

IV. What alternative imaging techniques are available?

  • No alternative diagnostic imaging modalities are available.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of transverse myelitis.

  • Not Applicable

VI. What are the contraindications for the alternative imaging techniques?

  • Not Applicable

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