MRI without and with IV contrast is useful to demonstrate spinal cord edema caused by venous hypertension and enlarged veins along the dorsal surface of the spinal cord. There may be patchy intramedullary enhancement due to breakdown of the blood-cord barrier. In some cases, abnormal vasculature may be identified that may be useful to guide spinal arteriography and intervention [5,89-91]. Primary and metastatic tumors of the spinal cord very rarely cause myelopathy and are best evaluated on contrast- enhanced MRI of the spine [92-96]. The distinction of syrinx from tumor, location of small tumor nodules, extent of cyst, and distinction of nodule and cyst from edema are crucial in treatment planning for intramedullary disease and best delineated with MRI [9,97]. In cases in which MRI shows findings suspicious for arachnoid cyst/arachnoid web or ventral cord herniation, CT myelography can be performed for further evaluation [79,80]. Likewise, in cases in which there is clinical concern for positional myelopathy, MRI with flexion/extension can be performed as a follow-up [78]. MRA Spine There is no relevant literature regarding the use of MRA in the initial imaging evaluation of chronic or progressive myelopathy. If MRI demonstrates findings concerning for an underlying vascular malformations, MRA can be performed as a follow-up to demonstrate abnormal vasculature that may be useful to guide spinal arteriography and intervention [5,89-91]. CT Myelography Spine CT myelography may be useful in this setting to answer specific questions before surgical intervention [72,73]. In cases in which MRI shows findings suspicious for arachnoid cyst/arachnoid web or ventral cord herniation, CT myelography can be performed for further evaluation [79,80]. Likewise, in cases in which there is clinical concern for positional myelopathy, extension/flexion positional CT myelography can be performed as a follow-up [98].
Myelopathy PCAs. MRI without and with IV contrast is useful to demonstrate spinal cord edema caused by venous hypertension and enlarged veins along the dorsal surface of the spinal cord. There may be patchy intramedullary enhancement due to breakdown of the blood-cord barrier. In some cases, abnormal vasculature may be identified that may be useful to guide spinal arteriography and intervention [5,89-91]. Primary and metastatic tumors of the spinal cord very rarely cause myelopathy and are best evaluated on contrast- enhanced MRI of the spine [92-96]. The distinction of syrinx from tumor, location of small tumor nodules, extent of cyst, and distinction of nodule and cyst from edema are crucial in treatment planning for intramedullary disease and best delineated with MRI [9,97]. In cases in which MRI shows findings suspicious for arachnoid cyst/arachnoid web or ventral cord herniation, CT myelography can be performed for further evaluation [79,80]. Likewise, in cases in which there is clinical concern for positional myelopathy, MRI with flexion/extension can be performed as a follow-up [78]. MRA Spine There is no relevant literature regarding the use of MRA in the initial imaging evaluation of chronic or progressive myelopathy. If MRI demonstrates findings concerning for an underlying vascular malformations, MRA can be performed as a follow-up to demonstrate abnormal vasculature that may be useful to guide spinal arteriography and intervention [5,89-91]. CT Myelography Spine CT myelography may be useful in this setting to answer specific questions before surgical intervention [72,73]. In cases in which MRI shows findings suspicious for arachnoid cyst/arachnoid web or ventral cord herniation, CT myelography can be performed for further evaluation [79,80]. Likewise, in cases in which there is clinical concern for positional myelopathy, extension/flexion positional CT myelography can be performed as a follow-up [98].