Myelopathy

D.J. Seidenwurm

Myelopathy describes any neurologic deficit related to the spinal cord. Myelopathy is usually due to compression of the spinal cord by osteophyte or extruded disk material in the cervical spine. Osteophytic spurring and disk herniation may also produce myelopathy localized to the thoracic spine, though less commonly. Other common sources of myelopathy are cord compression due to extradural mass caused by carcinoma metastatic to bone, and blunt or penetrating trauma. Many primary neoplastic, infectious, inflammatory, neurodegenerative, vascular, nutritional, and idiopathic disorders result in myelopathy, though these are very much less common than discogenic disease, metastases, and trauma. A variety of cysts and benign neoplasms may also compress the cord; these tend to arise intradurally. The most common of these are meningiomas, nerve sheath tumors, epidermoid cysts, and arachnoid cysts.^1–4

Disorders of the spinal cord itself generally are uncommon and difficult to treat effectively. Therefore, radiologic evaluation of myelopathy is primarily focused on extrinsic compression of the spinal cord. MR imaging is the mainstay in evaluation of myelopathy.¹ Imaging of the spinal cord has improved to the point that reliable diagnosis of nonexpansile spinal cord lesions is routinely possible.

Diagnosis and treatment of myelopathy rest on demonstration of mechanical stability of the spine, particularly in the cervical region and when tumor or trauma history is present. Depiction of direct neural involvement by a pathologic process is then required for more refined diagnosis and specific treatment decisions. Anatomic diagnosis rests principally on the distinction among extradural, intradural, and intramedullary lesions.

Clinically, the diagnosis of myelopathy depends on the neurologic localization of the finding to the spinal cord, rather than the brain or peripheral nervous system and then to a particular segment of the spinal cord. The antecedent clinical syndrome and other details of the patient's course are helpful, but imaging plays a crucial role. Clinical categories are based on the presence or absence of significant trauma or pain, and the mode of onset (slowly progressive or insidious onset versus stepwise progression versus sudden onset). Patients with known tumor history and those in whom infectious disease is likely are considered separately.

In traumatic myelopathy, the first priority is mechanical stability. Plain radiographs are sometimes useful for this purpose, but CT is more useful when a high probability of bony injury or ligamentous injury is present. In many centers, routine multidetector CT with sagittal and coronal reconstructions has replaced plain radiographs, especially in the setting of multiple trauma.

MR imaging is widely used when paralysis is incomplete or under other circumstances where direct visualization of neural or ligamentous structures is clinically necessary. If surgery for herniated disk, hematoma, or other cause of incomplete paralysis is planned, MR imaging best depicts the relation of pathology to the cord, and can help predict which patients may benefit from surgery.^5–10

When local or radicular pain accompanies myelopathy, the most likely diagnoses are spondylosis, tumor, and infection. Plain radiographs may depict osteophytic narrowing of the spinal canal or bone destruction. CT improves depiction of bony encroachment on the spinal canal and sometimes shows cord compression by herniated disk. Bone destruction and soft tissue masses may also be seen. MR imaging has replaced CT in noninvasive evaluation of patients with painful myelopathy because of superior soft tissue resolution and multiplanar capability. Invasive evaluation by means of myelography and CT myelography may be useful for surgical planning or other specific problem solving, though less frequently.^1,11–24

Although most commonly due to spondylosis and disk herniation, a significant proportion of painful myelopathy is caused by tumor or infection. Demyelinating disease may also present with pain. Occasionally, syringomyelia presents with anesthetica dolorosa. MR imaging depicts the spinal cord directly, assesses its contour and internal signal intensity characteristics reliably and noninvasively. MR imaging is the study of choice in cervical myelopathy when spondylosis or disk herniation is the most likely cause. When MR imaging is not available, or to answer specific questions before surgical intervention, myelography and CT myelography may be useful.^25–29

In slowly progressive myelopathy, the ability of MR imaging to depict the spinal cord is invaluable. Sometimes, specifically treatable disorders may be localized by myelography followed by CT. However, occasional catastrophic complications of myelography in cases of spinal block, difficulty in visualizing the upper extent of lesions, and relative “blind spots” at the cervical thoracic and craniocervical junctions limit utility. CT myelographic techniques may be useful to answer specific preoperative questions.

Enlargement of the spinal cord by intramedullary mass is depicted by myelography only when large masses are present, even when CT myelography supplements the plain examination. These techniques are much less useful than MR imaging because the distinction between solid and cystic masses is usually not possible, even when delayed examination is performed. The distinction of syrinx from tumor, location of tumor nodule, extent of cyst, and distinction of nodule and cyst from edema are crucial in treatment planning for intramedullary disease and virtually necessitate MR imaging.^30,31

When myelopathy progresses stepwise or is of sudden onset, vascular processes become significant diagnostic possibilities. Vascular malformations, spinal cord infarct, and epidural hematoma account for most vascular lesions of the cord. In practice, they are difficult to distinguish clinically from other nontraumatic causes of myelopathy because the classic history is frequently absent or difficult to elicit from a seriously ill patient.³²

If AVM is considered clinically likely, gadolinium-enhanced MR imaging, MRA, and myelography to demonstrate abnormal vasculature may be useful to guide spinal arteriography. More recently, progress in CT angiography has led to its use in preangiographic evaluation of patients with suspected spinal vascular abnormalities.³³

If myelopathy is painless and slowly progressive, the differential diagnosis is quite broad. Neoplastic disease of the spinal cord and extrinsic compression by epidural or intradural tumor may present in this manner. Demyelinating disease, degenerative diseases, and metabolic or deficiency diseases may also present in this fashion. Spondylosis may present painlessly as well, particularly in the elderly. In these cases, visualization of the spine as well as the spinal cord is useful and this is best accomplished noninvasively by MR imaging.^34–37

In oncology and infectious disease patients, multiple sites of involvement are possible. In these patients it is often necessary to study the entire spine or even the entire skeleton despite a specifically localized myelopathic level. MR imaging is considered more sensitive at an individual site, but the convenience of radionuclide bone scanning makes it useful in this setting as well. AIDS patients may present with myelopathy due to primary cord disease caused by HIV infection.^38–45

No high quality evidence supports the use of discography, thermography, epidural venography, sonography, or CSF flow studies in the evaluation of myelopathy. Radionuclide bone scan may play an adjunctive role, for example, to locate a safer biopsy site in patients with suspected metastatic cord compression.

An important limitation of MR imaging in the diagnosis of myelopathy is its high sensitivity. The ease with which the study depicts expansion and compression of the spinal cord in the myelopathic patient may lead to false-positive examinations and inappropriately aggressive therapy if findings are interpreted incorrectly. For example, transverse myelitis due to demyelinating disease may demonstrate cord enlargement and be mistaken for tumor. Spondylosis, which occurs with normal aging, may be mistaken for clinically significant osteophytic compression of the spinal cord in a patient who is myelopathic for other reasons. These problems are minimized by experienced observers and meticulous clinical correlation with radiologic findings. Similar problems are present in the interpretation of any anatomical study of the spinal cord and are not unique to MR imaging. Careful patient selection and clinical correlation are essential in interpretation of imaging findings.^1,46–48

Review Information

This guideline was originally developed in 1996. The last review and update was completed in 2006.

Appendix

Expert Panel on Neurologic Imaging: David J. Seidenwurm, MD, Principal Author and Panel Chair, Radiologic Associates of Sacramento, Sacramento, Calif; Patricia C. Davis, MD; James A. Brunberg, MD; Robert Louis De La Paz, MD; Pr. Didier Dormont; David B. Hackney, MD; John E. Jordan, MD; John P. Karis, MD; Suresh Kumar Mukherji, MD; Patrick A. Turski, MD; Franz J. Wippold II, MD; Robert D. Zimmerman, MD; Michael W. McDermott, MD, American Association of Neurlogical Surgeons; Michael A. Sloan, MD, MS, American Academy of Neurology.

Footnotes

This article is a summary of the complete version of this topic, which is available on the ACR Website at www.acr.org/ac. Practitioners are encouraged to refer to the complete version.
Reprinted with permission of the American College of Radiology.

References

↵
Kent DL, Haynor DR, Longstreth WT, Jr., et al. The clinical efficacy of magnetic resonance imaging in neuroimaging. Ann Intern Med 1994;120:856–71
PubMed
Rapoport RJ, Flanders AE, Tartaglino LM. Intradural extramedullary causes of myelopathy. Semin Ultrasound CT MR 1994;15:189–225
CrossRef PubMed
Rothman MI, Zoarski GH, Akhtar N. Extradural causes of myelopathy. Semin Ultrasound CT MR 1994;15:226–49
CrossRef PubMed
↵
Tartaglino LM, Flanders AE, Rapoport RJ. Intramedullary causes of myelopathy. Semin Ultrasound CT MR 1994;15:158–88
CrossRef PubMed
↵
Benzel EC, Hart BL, Ball PA, et al. Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. J Neurosurg 1996;85:824–29
PubMed
Davis SJ, Khangure MS. A review of magnetic resonance imaging in spinal trauma. Australas Radiol 1994;38:241–53
CrossRef PubMed
Flanders AE, Spettell CM, Friedman DP, et al. The relationship between the functional abilities of patients with cervical spinal cord injury and the severity of damage revealed by MR imaging. AJNR Am J Neuroradiol 1999;20:926–34
Abstract/FREE Full Text
Flanders AE, Spettell CM, Tartaglino LM, et al. Forecasting motor recovery after cervical spinal cord injury: value of MR imaging. Radiology 1996;201:649–55
PubMed
Hackney DB, Asato R, Joseph PM, et al. Hemorrhage and edema in acute spinal cord compression: demonstration by MR imaging. Radiology 1986;161:387–90
PubMed
↵
O'Beirne J, Cassidy N, Raza K, et al. Role of magnetic resonance imaging in the assessment of spinal injuries. Injury 1993;24:149–54
CrossRef PubMed
↵
An HS, Andreshak TG, Nguyen C, et al. Can we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging? Spine 1995;20:1776–82
PubMed
Baskaran V, Pereles FS, Russell EJ, et al. Myelographic MR imaging of the cervical spine with a 3D true fast imaging with steady-state precession technique: initial experience. Radiology 2003;227:585–92
CrossRef PubMed
Demir A, Ries M, Moonen CT, et al. Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy. Radiology 2003;229:37–43
CrossRef PubMed
Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg 2001;9:376–88
Abstract/FREE Full Text
Heldmann U, Myschetzky PS, Thomsen HS. Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression. Evaluation by low-field MR imaging in cancer patients. Acta Radiol 1997;38:372–75
PubMed
Kawakami M, Tamaki T, Yoshida M, et al. Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord 1999;12:50–56
PubMed
Martinelli V, Comi G, Rovaris M, et al. Acute myelopathy of unknown aetiology: a clinical, neurophysiological and MRI study of short- and long-term prognostic factors. J Neurol 1995;242:497–503
CrossRef PubMed
Matsumoto M, Fujimura Y, Toyama Y. Usefulness and reliability of neurological signs for level diagnosis in cervical myelopathy caused by soft disc herniation. J Spinal Disord 1996;9:317–21
PubMed
Matsuyama Y, Kawakami N, Mimatsu K. Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography. Spine 1995;20:1657–63
PubMed
Muhle C, Metzner J, Weinert D, et al. Kinematic MR imaging in surgical management of cervical disc disease, spondylosis and spondylotic myelopathy. Acta Radiol 1999;40:146–53
PubMed
Nagata K, Ohashi T, Abe J, et al. Cervical myelopathy in elderly patients: clinical results and MRI findings before and after decompression surgery. Spinal Cord 1996;34:220–26
PubMed
Papadopoulos CA, Katonis P, Papagelopoulos PJ, et al. Surgical decompression for cervical spondylotic myelopathy: correlation between operative outcomes and MRI of the spinal cord. Orthopedics 2004;27:1087–91
PubMed
Puzzilli F, Mastronardi L, Ruggeri A, et al. Intramedullary increased MR signal intensity and its relation to clinical features in cervical myelopathy. J Neurosurg Sci 1999;43:135–39; discussion 39
PubMed
↵
Suri A, Chabbra RP, Mehta VS, et al. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J 2003;3:33–45
CrossRef PubMed
↵
Goto S, Mochizuki M, Watanabe T, et al. Long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to the magnetic resonance imaging findings in 52 cases. Clin Orthop Relat Res 1993;142–53
Isoda H, Ramsey RG. MR imaging of acute transverse myelitis (myelopathy). Radiat Med 1998;16:179–86
PubMed
Morio Y, Yamamoto K, Kuranobu K, et al. Does increased signal intensity of the spinal cord on MR images due to cervical myelopathy predict prognosis? Arch Orthop Trauma Surg 1994;113:254–59
PubMed
Russell EJ. Cervical disk disease. Radiology 1990;177:313–25
PubMed
↵
Sadasivan KK, Reddy RP, Albright JA. The natural history of cervical spondylotic myelopathy. Yale J Biol Med 1993;66:235–42
PubMed
↵
Parizel PM, Baleriaux D, Rodesch G, et al. Gd-DTPA-enhanced MR imaging of spinal tumors. AJR Am J Roentgenol 1989;152:1087–96
PubMed
↵
Sze G, Krol G, Zimmerman RD, et al. Intramedullary disease of the spine: diagnosis using gadolinium-DTPA-enhanced MR imaging. AJR Am J Roentgenol 1988;151:1193–204
CrossRef PubMed
↵
Friedman DP, Tartaglino LM, Fisher AR, et al. MR imaging in the diagnosis of intramedullary spinal cord diseases that involve specific neural pathways or vascular territories. AJR Am J Roentgenol 1995;165:515–23
PubMed
↵
Atkinson JLD, Miller GM, Krauss WE, et al. Clinical and radiographic features of dural arteriovenous fistula, a treatable cause of myelopathy. Mayo Clin Proc 2001;76:1120–30
PubMed
↵
Howard AK, Li DK, Oger J. MRI contributes to the differentiation between MS and HTLV-I associated myelopathy in British Columbian coastal natives. Can J Neurol Sci 2003;30:41–48
PubMed
Locatelli ER, Laureno R, Ballard P, et al. MRI in vitamin B12 deficiency myelopathy. Can J Neurol Sci 1999;26:60–63
PubMed
Mok CC, Lau CS, Chan EY, et al. Acute transverse myelopathy in systemic lupus erythematosus: clinical presentation, treatment, and outcome. J Rheumatol 1998;25:467–73
PubMed
↵
Papadopoulos A, Gouliamos A, Trakadas S, et al. MRI in the investigation of patients with myelopathy thought to be due to multiple sclerosis. Neuroradiology 1995;37:384–87
CrossRef PubMed
↵
Blews DE, Wang H, Kumar AJ, et al. Intradural spinal metastases in pediatric patients with primary intracranial neoplasms: Gd-DTPA enhanced MR vs CT myelography. J Comput Assist Tomogr 1990;14:730–35
PubMed
Carmody RF, Yang PJ, Seeley GW, et al. Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography. Radiology 1989;173:225–29
PubMed
Chamberlain MC. Comparative spine imaging in leptomeningeal metastases. J Neurooncol 1995;23:233–38
CrossRef PubMed
Krol G, Sze G, Malkin M, et al. MR of cranial and spinal meningeal carcinomatosis: comparison with CT and myelography. AJR Am J Roentgenol 1988;151:583–88
PubMed
Li KC, Poon PY. Sensitivity and specificity of MRI in detecting malignant spinal cord compression and in distinguishing malignant from benign compression fractures of vertebrae. Magn Reson Imaging 1988;6:547–56
CrossRef PubMed
Post MJ, Sze G, Quencer RM, et al. Gadolinium-enhanced MR in spinal infection. J Comput Assist Tomogr 1990;14:721–29
PubMed
Wang PY, Shen WC, Jan JS. Serial MRI changes in radiation myelopathy. Neuroradiology 1995;37:374–77
PubMed
↵
Yousem DM, Patrone PM, Grossman RI. Leptomeningeal metastases: MR evaluation. J Comput Assist Tomogr 1990;14:255–61
PubMed
↵
Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72:1178–84
PubMed
Holtas S, Basibuyuk N, Fredriksson K. MRI in acute transverse myelopathy. Neuroradiology 1993;35:221–26
CrossRef PubMed
↵
Teresi LM, Lufkin RB, Reicher MA, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology 1987;164:83–88
PubMed

View this table:

Clinical condition: myelopathy

In this issue

Download PDF

Email Article

Citation Tools

Cited By...

More in this TOC Section

Show more ACR APPROPRIATENESS CRITERIA

[1] ↵
Kent DL, Haynor DR, Longstreth WT, Jr., et al. The clinical efficacy of magnetic resonance imaging in neuroimaging. Ann Intern Med 1994;120:856–71
PubMed

[2] Rapoport RJ, Flanders AE, Tartaglino LM. Intradural extramedullary causes of myelopathy. Semin Ultrasound CT MR 1994;15:189–225
CrossRef PubMed

[3] Rothman MI, Zoarski GH, Akhtar N. Extradural causes of myelopathy. Semin Ultrasound CT MR 1994;15:226–49
CrossRef PubMed

[4] ↵
Tartaglino LM, Flanders AE, Rapoport RJ. Intramedullary causes of myelopathy. Semin Ultrasound CT MR 1994;15:158–88
CrossRef PubMed

[5] ↵
Benzel EC, Hart BL, Ball PA, et al. Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. J Neurosurg 1996;85:824–29
PubMed

[6] Davis SJ, Khangure MS. A review of magnetic resonance imaging in spinal trauma. Australas Radiol 1994;38:241–53
CrossRef PubMed

[7] Flanders AE, Spettell CM, Friedman DP, et al. The relationship between the functional abilities of patients with cervical spinal cord injury and the severity of damage revealed by MR imaging. AJNR Am J Neuroradiol 1999;20:926–34
Abstract/FREE Full Text

[8] Flanders AE, Spettell CM, Tartaglino LM, et al. Forecasting motor recovery after cervical spinal cord injury: value of MR imaging. Radiology 1996;201:649–55
PubMed

[9] Hackney DB, Asato R, Joseph PM, et al. Hemorrhage and edema in acute spinal cord compression: demonstration by MR imaging. Radiology 1986;161:387–90
PubMed

[10] ↵
O'Beirne J, Cassidy N, Raza K, et al. Role of magnetic resonance imaging in the assessment of spinal injuries. Injury 1993;24:149–54
CrossRef PubMed

[11] ↵
An HS, Andreshak TG, Nguyen C, et al. Can we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging? Spine 1995;20:1776–82
PubMed

[12] Baskaran V, Pereles FS, Russell EJ, et al. Myelographic MR imaging of the cervical spine with a 3D true fast imaging with steady-state precession technique: initial experience. Radiology 2003;227:585–92
CrossRef PubMed

[13] Demir A, Ries M, Moonen CT, et al. Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy. Radiology 2003;229:37–43
CrossRef PubMed

[14] Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg 2001;9:376–88
Abstract/FREE Full Text

[15] Heldmann U, Myschetzky PS, Thomsen HS. Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression. Evaluation by low-field MR imaging in cancer patients. Acta Radiol 1997;38:372–75
PubMed

[16] Kawakami M, Tamaki T, Yoshida M, et al. Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord 1999;12:50–56
PubMed

[17] Martinelli V, Comi G, Rovaris M, et al. Acute myelopathy of unknown aetiology: a clinical, neurophysiological and MRI study of short- and long-term prognostic factors. J Neurol 1995;242:497–503
CrossRef PubMed

[18] Matsumoto M, Fujimura Y, Toyama Y. Usefulness and reliability of neurological signs for level diagnosis in cervical myelopathy caused by soft disc herniation. J Spinal Disord 1996;9:317–21
PubMed

[19] Matsuyama Y, Kawakami N, Mimatsu K. Spinal cord expansion after decompression in cervical myelopathy. Investigation by computed tomography myelography and ultrasonography. Spine 1995;20:1657–63
PubMed

[20] Muhle C, Metzner J, Weinert D, et al. Kinematic MR imaging in surgical management of cervical disc disease, spondylosis and spondylotic myelopathy. Acta Radiol 1999;40:146–53
PubMed

[21] Nagata K, Ohashi T, Abe J, et al. Cervical myelopathy in elderly patients: clinical results and MRI findings before and after decompression surgery. Spinal Cord 1996;34:220–26
PubMed

[22] Papadopoulos CA, Katonis P, Papagelopoulos PJ, et al. Surgical decompression for cervical spondylotic myelopathy: correlation between operative outcomes and MRI of the spinal cord. Orthopedics 2004;27:1087–91
PubMed

[23] Puzzilli F, Mastronardi L, Ruggeri A, et al. Intramedullary increased MR signal intensity and its relation to clinical features in cervical myelopathy. J Neurosurg Sci 1999;43:135–39; discussion 39
PubMed

[24] ↵
Suri A, Chabbra RP, Mehta VS, et al. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J 2003;3:33–45
CrossRef PubMed

[25] ↵
Goto S, Mochizuki M, Watanabe T, et al. Long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to the magnetic resonance imaging findings in 52 cases. Clin Orthop Relat Res 1993;142–53

[26] Isoda H, Ramsey RG. MR imaging of acute transverse myelitis (myelopathy). Radiat Med 1998;16:179–86
PubMed

[27] Morio Y, Yamamoto K, Kuranobu K, et al. Does increased signal intensity of the spinal cord on MR images due to cervical myelopathy predict prognosis? Arch Orthop Trauma Surg 1994;113:254–59
PubMed

[28] Russell EJ. Cervical disk disease. Radiology 1990;177:313–25
PubMed

[29] ↵
Sadasivan KK, Reddy RP, Albright JA. The natural history of cervical spondylotic myelopathy. Yale J Biol Med 1993;66:235–42
PubMed

[30] ↵
Parizel PM, Baleriaux D, Rodesch G, et al. Gd-DTPA-enhanced MR imaging of spinal tumors. AJR Am J Roentgenol 1989;152:1087–96
PubMed

[31] ↵
Sze G, Krol G, Zimmerman RD, et al. Intramedullary disease of the spine: diagnosis using gadolinium-DTPA-enhanced MR imaging. AJR Am J Roentgenol 1988;151:1193–204
CrossRef PubMed

[32] ↵
Friedman DP, Tartaglino LM, Fisher AR, et al. MR imaging in the diagnosis of intramedullary spinal cord diseases that involve specific neural pathways or vascular territories. AJR Am J Roentgenol 1995;165:515–23
PubMed

[33] ↵
Atkinson JLD, Miller GM, Krauss WE, et al. Clinical and radiographic features of dural arteriovenous fistula, a treatable cause of myelopathy. Mayo Clin Proc 2001;76:1120–30
PubMed

[34] ↵
Howard AK, Li DK, Oger J. MRI contributes to the differentiation between MS and HTLV-I associated myelopathy in British Columbian coastal natives. Can J Neurol Sci 2003;30:41–48
PubMed

[35] Locatelli ER, Laureno R, Ballard P, et al. MRI in vitamin B12 deficiency myelopathy. Can J Neurol Sci 1999;26:60–63
PubMed

[36] Mok CC, Lau CS, Chan EY, et al. Acute transverse myelopathy in systemic lupus erythematosus: clinical presentation, treatment, and outcome. J Rheumatol 1998;25:467–73
PubMed

[37] ↵
Papadopoulos A, Gouliamos A, Trakadas S, et al. MRI in the investigation of patients with myelopathy thought to be due to multiple sclerosis. Neuroradiology 1995;37:384–87
CrossRef PubMed

[38] ↵
Blews DE, Wang H, Kumar AJ, et al. Intradural spinal metastases in pediatric patients with primary intracranial neoplasms: Gd-DTPA enhanced MR vs CT myelography. J Comput Assist Tomogr 1990;14:730–35
PubMed

[39] Carmody RF, Yang PJ, Seeley GW, et al. Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography. Radiology 1989;173:225–29
PubMed

[40] Chamberlain MC. Comparative spine imaging in leptomeningeal metastases. J Neurooncol 1995;23:233–38
CrossRef PubMed

[41] Krol G, Sze G, Malkin M, et al. MR of cranial and spinal meningeal carcinomatosis: comparison with CT and myelography. AJR Am J Roentgenol 1988;151:583–88
PubMed

[42] Li KC, Poon PY. Sensitivity and specificity of MRI in detecting malignant spinal cord compression and in distinguishing malignant from benign compression fractures of vertebrae. Magn Reson Imaging 1988;6:547–56
CrossRef PubMed

[43] Post MJ, Sze G, Quencer RM, et al. Gadolinium-enhanced MR in spinal infection. J Comput Assist Tomogr 1990;14:721–29
PubMed

[44] Wang PY, Shen WC, Jan JS. Serial MRI changes in radiation myelopathy. Neuroradiology 1995;37:374–77
PubMed

[45] ↵
Yousem DM, Patrone PM, Grossman RI. Leptomeningeal metastases: MR evaluation. J Comput Assist Tomogr 1990;14:255–61
PubMed

[46] ↵
Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72:1178–84
PubMed

[47] Holtas S, Basibuyuk N, Fredriksson K. MRI in acute transverse myelopathy. Neuroradiology 1993;35:221–26
CrossRef PubMed

[48] ↵
Teresi LM, Lufkin RB, Reicher MA, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology 1987;164:83–88
PubMed

Main menu

User menu

Search

American Journal of Neuroradiology