The differentiation between acute complete or partial transverse myelitis is crucial because this can help distinguish between certain entities, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), a study found.
The study authors explained that typical medullary magnetic resonance imaging lesion patterns to differentiate medullary lesions include polio-like appearance with involvement of the anterior horns, longitudinal extensive transverse myelitis, short-range ovoid and peripheral lesions, and granulomatous nodular enhancement prototypes.
Read more about the NMOSD differential diagnosis
They said that acute partial transverse myelitis is most common at the onset of MS, while short transverse myelitis might occur at the onset of NMOSD. It is, therefore, of great importance to discriminate between acute complete and acute partial transverse myelitis.
However, they added that blood culture tests, cerebrospinal fluid analysis, and testing for autoantibody including antimyelin oligodendrocyte glycoprotein, antiaquaporin 4, and antiglial fibrillary acidic protein are crucial for the correct interpretation of imaging findings.
“The combination of neuroradiological features and neurological and laboratory findings including cerebrospinal fluid analysis improves diagnostic accuracy,” they wrote.
Finally, the authors stressed that in cases of suspected demyelinating, systemic autoimmune, infectious, paraneoplastic, and metabolic diseases, additional brain imaging is a must.
NMOSD is a rare chronic inflammatory disease of the central nervous system, which shares features of MS, but that is a separate entity. In most cases, autoantibodies against the aquaporin 4 water channel are seen. In some patients, there may also be autoantibodies against myelin oligodendrocyte glycoprotein alone or in combination with antiaquaporin 4. Finally, new evidence has emerged suggesting that antiGFAP antibodies may be a strong biomarker for the disease.
Weidauer S, Hattingen E, Arendt CT. Cervical myelitis: a practical approach to its differential diagnosis on MR imaging. Rofo. Published online July 6, 2023. doi:10.1055/a-2114-1350