E5367. Key MRI Features and Signs of Inflammatory Processes of the Spinal Cord
  1. Aaron Chong; Duke-NUS (National University of Singapore) Medical School; Sengkang General Hospital
  2. Chi Long Ho; Duke-NUS (National University of Singapore) Medical School; Sengkang General Hospital
Spinal cord diseases have a wide differential diagnosis and frequently pose a diagnostic challenge for clinicians and radiologists. MRI is often the diagnostic method of choice.

Educational Goals / Teaching Points
Our study aims to comprehensively outline the key MRI features and signs of different inflammatory conditions involving the spinal cord.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multiple sclerosis demonstrates short segments with high T2-weighted (T2W) signal and postcontrast enhancement along the spinal cord, giving the “open ring” sign. Idiopathic transverse myelitis is a longitudinally extensive transverse myelitis (LETM) involving 3–4 segments with T2W hyperintensity in both halves of the spinal cord. Guillian-Bare Syndrome (GBS) is an autoimmune polyradiculopathy that involves the dorsal root ganglia and the conus medullaris. Syphilitic myelitis affects 80% of males, with the prevalent age between 17 and 63 years. It demonstrates cord atrophy with predominant T2W hyperintensity of the dorsal columns and pachymeningeal enhancement. “Flip-flop” sign and “candle guttering” are classic appearances. Lupus myelitis is a LETM involving the central cord and can be associated with multiple acute cord lacunar infarcts. Antimyelin oligodendrocyte glycoprotein (MOG) disease demonstrates longitudinally extensive T2-hyperintense lesions with enhancement, and ‘H” sign on axial T2W MRI. Neuromyelitis optica spectrum disorder (NMOSD) is a LETM extending over three or more vertebral segments, and demonstrates periependymal lesions, "cloud-like" appearance and/or “bright spotty” sign on axial T2W MRI. Acute disseminated encephalomyelitis (ADEM) demonstrates postviral, multifocal large demyelinating lesions, involving gray and white matter of the cord. Subacute combined degeneration (due to intrathecal methotrexate, nitrous oxide intoxication and B12 deficiency) demonstrate symmetric T2-hyperintense lesions in posterior > lateral columns with inverted “V” sign or “rabbit ear” sign.

Our study emphasizes the importance of recognizing these specific imaging characteristics and signs in different inflammatory processes of the spinal cord. The various forms of myelitis with distinct patterns of involvement can enhance the radiologist's ability to provide an accurate differential diagnosis and guide clinical management. This knowledge aids in optimizing patient care and treatment decisions.