Compressive myelopathy: magnetic resonance imaging findings simulating idiopathic acute transverse myelopathy

Objective To provide magnetic resonance imaging (MRI) findings of compressive myelopathy simulating idiopathic acute transverse myelopathy (ATM). Materials and methods From 19,416 patients who had spinal MRI from 1 September 2004 to 10 July 2011, the patients who met inclusion criteria were enrolled as follows: (1) definable cord compression, (2) long-segmental intramedullary T2-high signal intensity (HSI) extending more than 2 vertebral segments, and (3) no history of trauma, malignancy, or demyelinating disease. The characteristics of T2-HSI and contrast enhancement pattern were analyzed. The patients’ clinical information was collected in the process. Results Thirteen patients (10 men, 3 women; mean age, 52.8 years; age range, 43–77 years) were included in this study. Twelve patients had cervical cord compression and one had thoracic compression. Common findings of T2-HSI included fusiform shape (100 %) with cord swelling (92.3 %), cord compression in midline location (76.9 %), diffuse distribution occupying more than two-thirds of the cross-sectional dimension of the cord in axial image (84.6 %), and focal and peripheral enhancement (63.6 %). Intravenous corticosteroid was administered to four patients, including two patients following decompressive surgery, and interval decrease in T2-HSI was seen in three patients, but with residual lesions at cord compression level. Conclusions Spinal cord compression can induce long-segmental cord signal change, such as idiopathic ATM.