MRI has superior soft-tissue resolution and multiplanar capability, making it ideal for evaluation of the spinal canal and its contents as well as the surrounding osseous and soft-tissue structures [13-15,33-36]. Myelopathy Intramedullary cord signal changes on MRI in patients with spondylotic myelopathy represent prognostic factors for neurosurgical outcome [21,37-41]. Intravenous (IV) contrast is typically not required for the diagnosis of spondylotic myelopathy, but characteristic patterns of enhancement can be seen immediately at and below a level of stenosis [42,43]. In patients who have undergone spinal surgery, complications in the early postoperative setting (eg, hematoma) can result in extrinsic compression of the spinal cord and are best evaluated using MRI without and with IV contrast [44]. In cases in which spinal cord ischemia is suspected as the cause for acute myelopathy, MRI without and with IV contrast is useful in cases where spinal cord ischemic is suspected as the cause for acute myelopathy [27,28,45-47]. Contrast enhancement is typically not seen in the early phase of acute ischemia and, if present, may suggest an alternative inflammatory or infectious etiology [48]. Diffusion-weighted imaging can show signal alteration in the spinal cord earlier after patient symptom onset compared with T2-weighted images [49,50]. As such, diffusion- weighted imaging should be included anytime there is concern for spinal cord ischemia [51]. When considering inflammatory or infections etiologies of myelopathy, visualization of the osseous spinal column as well as the spinal cord is useful and best accomplished noninvasively by MRI [4,7,45,52-60]. Demyelinating diseases such as MS and NMO can present as acute myelopathy. MS is the classic demyelinating disease and is characterized by lesions affecting the spinal cord (and brain) and clinical defects disseminated in space and time [61].
Myelopathy PCAs. MRI has superior soft-tissue resolution and multiplanar capability, making it ideal for evaluation of the spinal canal and its contents as well as the surrounding osseous and soft-tissue structures [13-15,33-36]. Myelopathy Intramedullary cord signal changes on MRI in patients with spondylotic myelopathy represent prognostic factors for neurosurgical outcome [21,37-41]. Intravenous (IV) contrast is typically not required for the diagnosis of spondylotic myelopathy, but characteristic patterns of enhancement can be seen immediately at and below a level of stenosis [42,43]. In patients who have undergone spinal surgery, complications in the early postoperative setting (eg, hematoma) can result in extrinsic compression of the spinal cord and are best evaluated using MRI without and with IV contrast [44]. In cases in which spinal cord ischemia is suspected as the cause for acute myelopathy, MRI without and with IV contrast is useful in cases where spinal cord ischemic is suspected as the cause for acute myelopathy [27,28,45-47]. Contrast enhancement is typically not seen in the early phase of acute ischemia and, if present, may suggest an alternative inflammatory or infectious etiology [48]. Diffusion-weighted imaging can show signal alteration in the spinal cord earlier after patient symptom onset compared with T2-weighted images [49,50]. As such, diffusion- weighted imaging should be included anytime there is concern for spinal cord ischemia [51]. When considering inflammatory or infections etiologies of myelopathy, visualization of the osseous spinal column as well as the spinal cord is useful and best accomplished noninvasively by MRI [4,7,45,52-60]. Demyelinating diseases such as MS and NMO can present as acute myelopathy. MS is the classic demyelinating disease and is characterized by lesions affecting the spinal cord (and brain) and clinical defects disseminated in space and time [61].