Transverse myelitis x ray
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Julinka Auta Fernandes
Overview
- Plain spinal radiography (X-ray) cannot directly demonstrate inflammation within the spinal cord and has no established role in confirming or excluding transverse myelitis.
- The 2026 American College of Radiology (ACR) Appropriateness Criteria rate radiography of the relevant spinal region as Usually Not Appropriate for the initial imaging evaluation of acute-onset myelopathy. The guideline found no relevant literature supporting spinal radiography as the initial imaging examination in this setting.[1]
- Published consensus diagnostic criteria for acute transverse myelitis do not include plain radiography as a diagnostic or confirmatory test.[2]
X-ray
| Clinical question | Evidence-based interpretation |
|---|---|
| Disease-specific finding | None established. Plain radiographs do not show intramedullary inflammation or spinal-cord signal abnormality. |
| Diagnostic performance | Sensitivity, specificity, and predictive values for diagnosing transverse myelitis have not been established because radiography is not a diagnostic test for the disorder. |
| Routine use | Spinal radiography is not recommended as routine initial imaging for suspected transverse myelitis or acute myelopathy.[1] |
| Limited adjunctive use | Radiography may be obtained only when a separate clinical question concerns an osseous or alignment abnormality, such as suspected fracture, deformity, destructive bone disease, marked degenerative change, or dynamic spinal instability. Such findings may identify an alternative or coexisting condition but do not diagnose transverse myelitis.[1] |
| Normal radiograph | A normal X-ray does not exclude transverse myelitis or another clinically important cause of myelopathy.[1][2] |
Clinical interpretation
- There is no confirmatory X-ray appearance of transverse myelitis.
- Any radiographic abnormality should be interpreted as evidence of a separate osseous or structural process rather than as evidence of transverse myelitis.
- Plain radiography should not be used as a screening, confirmatory, or exclusion test for transverse myelitis.
References
- ↑ 1.0 1.1 1.2 1.3 Peckham M, Hutchins TA, Amrhein TJ, et al.; Expert Panel on Neurological Imaging. 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. PMID: 42340276.
- ↑ 2.0 2.1 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. PMID: 12236201.