Autoimmune diseases of the spine and spinal cord

Abstract

Magnetic resonance imaging (MRI) and clinicopathological tools have led to the identification of a wide spectrum of autoimmune entities that involve the spine. A clearer understanding of the unique imaging features of these disorders, along with their clinical presentations, will prove invaluable to clinicians and potentially limit the need for more invasive procedures such as tissue biopsies. Here, we review various autoimmune diseases affecting the spine and highlight salient imaging features that distinguish them radiologically from other disease entities.

Keywords: Spine; autoimmune; demyelinating.

Figure 1.

(a) Sagittal STIR, (b) sagittal T2w, and (c) axial T2w through C2 images demonstrating short segment dorsolateral T2 hyperintensities of the cervical spinal cord in multiple sclerosis.

Figure 2.

(a) Sagittal T2w, (b) axial T2w images through C2 demonstrate longitudinally extensive expansile transverse myelitis lesions involving the whole cross section of the cord in NMOSD. In a different patient, (c) sagittal and (d) axial post-contrast through T11 show peripheral enhancement of lesions.

Figure 3.

(a) Sagittal T2w, (b) sagittal STIR, (c) axial post-contrast T1w through C5 demonstrating longitudinally extensive transverse myelitis lesions of the central cord in an “H-shaped” pattern in addition to brainstem lesions.

Figure 4.

(a) Sagittal T1w, (b) Sagittal T2w, and (c) axial post-contrast T1w through L2 demonstrating thickened cauda equina roots with ventral enhancement in GBS/AIDP.

Figure 5.

(a) Sagittal T1w, (b) sagittal T2w, (c) axial T2w through L4, and (d) post- contrast T1w images through L1–L2 demonstrating thickened, enhancing, mildly nodular nerve roots in CIDP.

Figure 6.

(a) Sagittal post-contrast T1w and (b) sagittal T2w images and (c) axial post-contrast T1w image through T11 demonstrate fusiform cord enlargement with hyperintense T2w signal and heterogenous enhancement.

Figure 7.

(a) Sagittal T2w and (b) axial T2w images though C5 demonstrating longitudinally extensive signal in the anterolateral cervical cord in SLE.

Figure 8.

(a) Sagittal T2w and (b) axial T2w images through C2 demonstrating atypical short segment hyperintense signal with a central pattern in a patient with Sjogren Syndrome. Typically lesions are longitudinally extensive.

Figure 9.

(a) Normal sagittal T2w and (b) axial T2w image in a patient with Stiff-Person Syndrome.

Figure 10.

(a) Sagittal T2w and (b) axial T2w image through T5 demonstrating longitudinally extensive hyperintense lesions in transverse myelitis.

Figure 11.

(a) Sagittal T2w and (b) axial T2w images though C3 demonstrating longitudinally extensive lesions with expansile morphology and hyperintense signal in ADEM.

Figure 12.

(a) Sagittal T2w and (b) axial T2w image through C4 demonstrating longitudinally extensive lesions with hyperintense signal involving the central cervical cord in a COVID patient.

Figure 13.

(a) Sagittal STIR, (b) sagittal T2w, and (c) axial T2w images through C4 demonstrating longitudinally extensive lesions with hyperintense signal predominantly involving the central gray matter in post viral acute flaccid myelitis.