Preliminary Diagnosis: Transverse myelitis
I. What imaging technique is first-line for this diagnosis
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MR imaging with IV contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of transverse myelitis.
Advantages
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Diagnostic with positive pertinent findings: central cord lesion >2 vertebral body segments +/- patchy enhancement.
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Able to locate the level of infection and inflammation and predict any neurological (sensory, motor) and specifically dermatomal abnormalities.
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Able to rule out any secondary complications from a primary infectious or inflammatory transverse myelitis: such as discitis, osteomyelitis, or epidural abscess.
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Does not use ionizing radiation.
Disadvantages
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Expensive
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Time-consuming imaging modality
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Requires significant patient cooperation to limit motion artifact.
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40-50% of cases of transverse myelitis are not demonstrated by MR.
III. What are the contraindications for the first-line imaging technique?
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Contraindicated in patients with non-MR compatible hardware and noncompatible foreign bodies.
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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?
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No alternative diagnostic imaging modalities are available.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of transverse myelitis.
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Not Applicable
VI. What are the contraindications for the alternative imaging techniques?
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Not Applicable
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