1. 22Demyelinating and
Inflammatory Disease of the
Spinal Cord on Magnetic
Resonance Imaging

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig SP 22-1 Multiple sclerosis. (A) T1-weighted
and (B) T2-weighted sagittal images show
focal enlargement of the cord at the C2 level
that demonstrates high signal intensity (arrow,
B).20

4. • Fig SP 22-2 Multiple sclerosis. (A) Sagittal T2-weighted image shows
focal increased signal posteriorly (arrows) at the level of C3 in a
normal-sized spinal cord. The plaque is approximately half a
vertebral segment in length and is longer than it is wide. (B) Axial
T2-weighted scan through the plaque shows the typical peripheral
posterolateral location in cross section (arrow). Note that the
plaque involves less than half the cross-sectional area of the cord.
(C) Axial proton-density image at the same level shows clear
involvement of the left dorsal and lateral horns of the central gray
matter (large arrows) compared with the appearance of the normal
right dorsal and lateral horns (small arrows).21

5. • Fig SP 22-3 Transverse myelitis. T2-weighted
sagittal images in a young boy with rapid onset of
back pain and paraplegia 3 weeks after a viral
illness show diffuse, increased signal intensity in
the cord, consistent with edema.20

6. • Fig SP 22-4 Inflammatory myelitis. (A) Initial parasagittal proton-
density image shows diffuse enlargement of the thoracic cord,
which has a heterogeneously high signal. (B) After contrast
administration, there are several areas of abnormal enhancement
within the enlarged thoracic cord. The largest of these areas
demonstrates a peripheral, diffuse pattern of enhancement (arrow).
A separate area of enhancement is noted superiorly (curved arrow).
(Courtesy of Linda L. Coleman, M.D.)22

7. • Fig SP 22-5 AIDS-related myelopathy. T2-
weighted sagittal image demonstrates high
intramedullary signal in a somewhat swollen
area of the thoracic cord.20

8. • Fig SP 22-6 Postradiation myelitis. T2-weighted
image after radiation therapy for laryngeal cancer
shows increased signal intensity (arrows) in the
spinal cord from C4-C7.11

9. • Fig SP 22-7 Intramedullary sarcoidosis. (A)
Sagittal and (B) axial T1-weighted images after
injection of contrast material show an
enhancing intramedullary mass (arrow, A)
indistinguishable from a glioma.20

10. • Fig SP 22-8 Pial sarcoidosis. T1-weighted axial
image of the thoracic region of the spine after
injection of contrast material demonstrates
pial enhancement along the conus (arrows).
The patient's bilateral lower extremity
numbness resolved after steroid therapy.20