KEY FACTS Terminology Noncompressive myelopathy Acute transverse myelopathy (ATM) is broad generic term encompassing heterogeneous group of disorders causing cord dysfunction Etiologies include inflammatory causes (ATM) + vascular disease + radiation + paraneoplastic + idiopathic (unknown) ATM is more specific…
KEY FACTS Terminology Infection in setting of immunocompromised state HIV(+) Chronic/systemic illness Steroid therapy Cancer ± chemotherapy Imaging CT → define osseous involvement MR → evaluate extent of intramedullary, intradural extramedullary, and extradural involvement Discitis/osteomyelitis → loss of disc height,…
KEY FACTS Terminology Myelopathy resulting from primary HIV infection Most common cause of spinal cord disease in AIDS patients; prevalence of 20-55% Imaging Most common: Atrophy Spinal cord T2 hyperintensity ± patchy enhancement Thoracic > cervical; ↑ rostral as disease…
KEY FACTS Terminology Acute inflammatory insult of spinal cord due to direct viral infection or postviral immunologic attack Imaging Swollen, edematous spinal cord with segmental contiguous involvement From 1 segment to extensive cord involvement Fusiform expansion of spinal cord Diffuse…
KEY FACTS Terminology Spinal subdural abscess (SSA) Intradural extramedullary ring-enhancing fluid collection of pus in “potential” space between dura and arachnoid Imaging Thoracolumbar region most common Presence suggested by mass effect on cord and obliterated subarachnoid space Cord displacement: ±…
KEY FACTS Terminology Spinal epidural abscess Extradural spinal infection with abscess formation Imaging Lower thoracic and lumbar > upper thoracic and cervical CT Enhancing epidural mass narrowing central canal MR T1WI: Iso- to hypointense to cord T2WI/STIR: Hyperintense T1WI C+:…
KEY FACTS Terminology Paraspinal phlegmon surrounding peripherally enhancing fluid collections Imaging Pre vertebral/ para vertebral space Multiple or multiloculated collections along muscle plane NECT Amorphous low-density intramuscular collection Calcified psoas abscesses characteristic of tuberculous paraspinal abscess Endplate destruction MR Iso-…
KEY FACTS Terminology Tuberculosis (TB); TB spondylitis (TS) Extrapulmonary granulomatous infection of spine/adjacent tissues Also known as Pott (Pott's) disease Imaging Gibbus vertebrae with relatively intact intervertebral discs, large paraspinal abscesses Midthoracic or thoracolumbar > lumbar, cervical Isolated posterior element…
KEY FACTS Imaging MR Diffuse, extensive subarachnoid enhancement Smooth or irregular meningeal enhancement Top Differential Diagnoses Carcinomatous meningitis Focal or diffuse, sheet-like or nodular enhancement along cord or nerve roots Sarcoidosis Leptomeningeal + nerve root enhancement mimics spinal meningitis Lumbar…
Anatomy-Based Imaging Issues Spread of infection may occur along 1 of many different tracts, including direct extension , lymphatic spread , hematogenous spread , and along the cerebrospinal fluid pathways . Direct extension , as its name implies, occurs when…