Spinal cord involvement is seen in 80% to 90% of patients with MS, most commonly affecting the cervical cord [62]. Patients with primary progressive MS tend to have more spinal cord involvement than patients with relapsing-remitting MS [12]. When myelopathy due to MS is suspected, MRI detection of spinal cord lesion(s) fulfills part of the 2016 Magnetic Resonance Imaging in MS (MAGNIMS) criteria [63]. NMO is a demyelinating condition characterized by optic neuritis and spinal cord lesions. Brain lesions are not as commonly encountered in NMO as in MS, so, when present, tend to predominate in regions around the third and fourth ventricles [64-66]. ADEM is a demyelinating condition that typically manifests as encephalopathy. Spinal cord involvement is present in approximately 25% of cases of ADEM. MRI of the spine is generally considered the reference standard for imaging of the spinal cord in cases of suspected demyelinating disease [63,67,68] in addition to excluding alternative etiologies. Contrast-enhanced imaging is recommended for initial diagnostic evaluation [69,70]. MRA Spine There is no relevant literature regarding the use of MR angiography (MRA) in the initial imaging evaluation of acute onset myelopathy. In cases of spinal cord ischemia, MRA can be used to identify the artery of Adamkiewicz or vertebral artery dissection/occlusion and should be considered as a follow-up to MRI [12]. Although MRA can be performed for suspected spinal vascular malformations in patients with hematomyelia, conventional angiography remains necessary for complete lesion characterization [71]. CT Myelography Spine CT myelography may be useful in this clinical setting to answer specific questions before surgical intervention [72,73]. In spondylotic myelopathy, conventional myelography can be used to diagnose severe canal stenosis [74]. MRI, however, is best for evaluation of the marrow and the spinal canal/spinal cord [13-15].
Myelopathy PCAs. Spinal cord involvement is seen in 80% to 90% of patients with MS, most commonly affecting the cervical cord [62]. Patients with primary progressive MS tend to have more spinal cord involvement than patients with relapsing-remitting MS [12]. When myelopathy due to MS is suspected, MRI detection of spinal cord lesion(s) fulfills part of the 2016 Magnetic Resonance Imaging in MS (MAGNIMS) criteria [63]. NMO is a demyelinating condition characterized by optic neuritis and spinal cord lesions. Brain lesions are not as commonly encountered in NMO as in MS, so, when present, tend to predominate in regions around the third and fourth ventricles [64-66]. ADEM is a demyelinating condition that typically manifests as encephalopathy. Spinal cord involvement is present in approximately 25% of cases of ADEM. MRI of the spine is generally considered the reference standard for imaging of the spinal cord in cases of suspected demyelinating disease [63,67,68] in addition to excluding alternative etiologies. Contrast-enhanced imaging is recommended for initial diagnostic evaluation [69,70]. MRA Spine There is no relevant literature regarding the use of MR angiography (MRA) in the initial imaging evaluation of acute onset myelopathy. In cases of spinal cord ischemia, MRA can be used to identify the artery of Adamkiewicz or vertebral artery dissection/occlusion and should be considered as a follow-up to MRI [12]. Although MRA can be performed for suspected spinal vascular malformations in patients with hematomyelia, conventional angiography remains necessary for complete lesion characterization [71]. CT Myelography Spine CT myelography may be useful in this clinical setting to answer specific questions before surgical intervention [72,73]. In spondylotic myelopathy, conventional myelography can be used to diagnose severe canal stenosis [74]. MRI, however, is best for evaluation of the marrow and the spinal canal/spinal cord [13-15].