E1422. Imaging of Immune-Mediated and Inflammatory Induced Myelopathies
  1. Christian Park; Penn State Milton S. Hershey Medical Center
  2. Puneet Kochar; Penn State Milton S. Hershey Medical Center
  3. Sangam Kanekar; Penn State Milton S. Hershey Medical Center
  4. Einat Slonimsky; Penn State Milton S. Hershey Medical Center
Myelopathy is a spinal cord dysfunction and still remains a clinical diagnosis. Though the diagnosis is easy but to pinpoint, the cause still remains challenging. Despite the small size of the spinal cord, its presentation largely depends on the tracts affected and the disease process. Neuroimaging and laboratory studies provide supportive evidence or can identify a cause of myelopathy or helps to limit the differential diagnosis in this nonspecific clinical presentation.

Educational Goals / Teaching Points
1. To review the anatomy of the spinal cord and discuss the clinical findings and pathology/ pathogenesis of the immune-mediated and inflammatory induced myelopathies. 2. To highlight the imaging findings and diagnostic pearls for the specific diagnosis of the immune-mediated and inflammatory induced myelopathies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We retrospectively reviewed the imaging studies of 241 patients with Myelopathy. All patients had a contrast-enhanced MRI of the spine and CSF examinations at the time of the presentation. 112 patients had a follow-up MR of the spine. We classified these cases into: Myelitis with autoimmune-/immune-mediated CNS disorders; ; Multiple sclerosis (MS) Neuromyelitis optica spectrum disorder (NMOSD), [AQP4-positive NMOSD, AQP4-negative NMOSD], Novel autoantibody-positive disorders with myelitis [Anti-MOG myelin oligodendrocyte glycoprotein (MOG) IgG associated disease, Anti-GFAP], Acute disseminated encephalomyelitis (ADEM), Idiopathic transverse, Myelitis, Paraneoplastic, Para-/postinfectious, Para-/post-vaccinal, Anti-TNFa agents. Myelitis as a complication of inflammatory multisystem disorders: Sarcoidosis, Systemic lupus erythematosus (SLE), Behçet’s disease, mixed connective tissue disease (MCTD), Myelitis associated with antiphospholipid syndrome, Sjogren-associated myelitis.

Making a specific diagnosis and the cause of the myelopathy is always challenging in clinical practice. Diagnosis requires a multi-disciplinary approach. Imaging plays an important role in identifying the pathology and can make a specific diagnosis in an appropriate clinical setting.