Transverse myelitis other imaging findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Julinka Auta Fernandes
Overview
- There is no routinely recommended “other” imaging modality with findings that independently confirm or exclude transverse myelitis.
- Magnetic resonance imaging (MRI) remains the preferred imaging modality for suspected transverse myelitis. Other imaging procedures should be used selectively when MRI cannot be performed or when a separate structural, vascular, inflammatory, infectious, or neoplastic disorder is suspected.[1][2]
- Abnormalities identified by these targeted studies generally establish an alternative diagnosis or an underlying cause of myelopathy; they are not characteristic imaging findings of transverse myelitis.
Other imaging modalities
| Imaging modality | Potential indication | Interpretation and limitation |
|---|---|---|
| Conventional myelography or computed tomography myelography | May be considered when MRI is contraindicated, unavailable, technically unsuccessful, or nondiagnostic and exclusion of an extra-axial compressive lesion remains necessary. | Myelography may demonstrate spinal canal narrowing, displacement of the contrast column, or another structural cause of spinal cord compression. It does not reliably demonstrate intrinsic spinal cord inflammation and cannot independently confirm transverse myelitis. The Transverse Myelitis Consortium Working Group permits MRI or myelography for exclusion of extra-axial compression but states that conventional computed tomography (CT) alone is inadequate for this purpose.[3][2] |
| Catheter spinal angiography | Should be reserved for patients in whom the clinical presentation or preceding imaging raises specific concern for a spinal arteriovenous fistula, arteriovenous malformation, or another vascular abnormality. | Digital subtraction angiography (DSA) is not a routine test for transverse myelitis. The American College of Radiology (ACR) rates spinal arteriography as usually not appropriate for the initial evaluation of unselected acute or chronic myelopathy.[2] Demonstration of a causative vascular shunt or malformation indicates a vascular myelopathy rather than idiopathic transverse myelitis. |
| Positron emission tomography and other nuclear medicine imaging | May be obtained only when there is an independent clinical indication to investigate an underlying systemic disorder, such as occult malignancy, granulomatous inflammation, or infection. | There is no established positron emission tomography or scintigraphic appearance that confirms transverse myelitis. These examinations are not part of the ACR-recommended initial imaging evaluation for suspected transverse myelitis.[1] Any abnormality should be attributed to the underlying systemic condition rather than interpreted as a direct imaging finding of transverse myelitis. |
| Other specialized imaging | May be selected for a specific alternative diagnosis according to the clinical presentation. | No other specialized imaging technique has a validated sensitivity or specificity sufficient to confirm or exclude transverse myelitis. |
Clinical interpretation
- Other imaging modalities must not replace appropriate spinal MRI when MRI can be safely and adequately performed.
- A normal myelogram, angiogram, or nuclear medicine examination does not exclude transverse myelitis.
- Identification of spinal cord compression, a vascular shunt, tumor, infection, or another structural abnormality should redirect the evaluation toward that alternative cause of myelopathy.
- No finding on myelography, spinal angiography, positron emission tomography, or scintigraphy forms part of the established criteria for demonstrating spinal cord inflammation in transverse myelitis.[3]
References
- ↑ 1.0 1.1 Kalnins A, Lewis LM, Soderlund KA, et al. ACR Appropriateness Criteria® Demyelinating Diseases. Journal of the American College of Radiology. 2026;23(6):1183-1214. doi:10.1016/j.jacr.2026.02.003. PubMed identifier: 41762178.
- ↑ 2.0 2.1 2.2 Peckham M, Hutchins TA, Amrhein TJ, et al. ACR Appropriateness Criteria® Myelopathy: 2026 Update. Journal of the American College of Radiology. 2026;23(9):1870-1883. doi:10.1016/j.jacr.2026.06.003. PubMed identifier: 42340276.
- ↑ 3.0 3.1 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002;59(4):499-505. doi:10.1212/WNL.59.4.499. PubMed identifier: 12236201.