Pediatric Transverse Myelitis

  • Etiology: Infectious or postinfectious leading to cord inflammation and demyelination
  • Imaging MRI:
    — Central location in cord
    — Smooth cord enlargement
    — Greater than 2 vertebral body segments in length (long segment)
    — Greater than 1/2 cross sectional area of cord
    — T1WI post contrast: Enhancement absent or patchy
    — DWI: No restricted diffusion
  • Note: No lesions are seen in the brain
  • DDX: Multiple sclerosis or Acute disseminated encephalomyelitis
    — Peripheral-posterolateral location in cord
    — Less than 2 vertebral body segments in length (short segment)
    — Less than 1/2 cross sectional area of cord
    — Enhancement related to activity
  • Complications:
  • Treatment:
  • Clinical:

Radiology Cases of Transverse Myelitis

MRI of transverse myelitis
Sagittal and axial T2 MRI of the thoracic spine shows centrally located continuous bright signal through the thoracic spinal cord that ends just above the conus medullaris.
MRI of pediatric transverse myelitis
Sagittal T2 (left) and sagittal STIR (middle) MRI of the spine show a high signal intensity lesion throughout the spinal cord from the C4 to T12 vertebral body levels which is most prominent from C4 to C7. There is smooth spinal cord expansion throughout the length of the lesion. Axial T2 MRI (right) shows the lesion is centrally located in the spinal cord and is greater than half of the cross sectional area of the spinal cord. Sagittal T1 MRI with contrast (not provided) showed no contrast enhancement of the lesion.