Compressive myelopathy: magnetic resonance imaging findings simulating idiopathic acute transverse myelopathy

Abstract

Objective: To provide magnetic resonance imaging (MRI) findings of compressive myelopathy simulating idiopathic acute transverse myelopathy (ATM).

Materials and methods: From 19,416 patients who had spinal MRI from 1 September 2004 to 10 July 2011, the patients who met inclusion criteria were enrolled as follows: (1) definable cord compression, (2) long-segmental intramedullary T2-high signal intensity (HSI) extending more than 2 vertebral segments, and (3) no history of trauma, malignancy, or demyelinating disease. The characteristics of T2-HSI and contrast enhancement pattern were analyzed. The patients' clinical information was collected in the process.

Results: Thirteen patients (10 men, 3 women; mean age, 52.8 years; age range, 43-77 years) were included in this study. Twelve patients had cervical cord compression and one had thoracic compression. Common findings of T2-HSI included fusiform shape (100 %) with cord swelling (92.3 %), cord compression in midline location (76.9 %), diffuse distribution occupying more than two-thirds of the cross-sectional dimension of the cord in axial image (84.6 %), and focal and peripheral enhancement (63.6 %). Intravenous corticosteroid was administered to four patients, including two patients following decompressive surgery, and interval decrease in T2-HSI was seen in three patients, but with residual lesions at cord compression level.

Conclusions: Spinal cord compression can induce long-segmental cord signal change, such as idiopathic ATM.