LONG SEGMENT >3 vertebral segments

INDEX

                                                                                

                                                                                                                         Short Segment Myelopathy                      MCQs on this topic   

TIE FIGHTER

LOCATION
 

SAGITTAL T2

POST CONTRAST SAGITTAL

Other features

 

 

 

 

From: Ref 2

 

Multiple1.
Long in 70%; short in 30%.
Myelitis can occur in isolation but is more
commonly seen with concomitant
involvement of the brain and brainstem
 as part of ADEM or concurrently with an
episode of optic neuritis2.

 

T2 signal confined to gray matter: longitudinally
extensive T2 hyperintensity that forms a sagittal
line (with hazy hyperintensity of the anterior and
posterior horns)1.
Lesions may subsequently resolve completely2.

 

Faint/patchy or no enhancement1
except cauda equina.
Ring enhancement not a feature.

From: Ref 2

Frequent involvement of conus.
A third had involvement of area
postrema1
With MOG-IgG–associated disorder,
cerebral manifestations can reveal
ADEM-like lesions, including
multifocal white matter lesions, deep gray
matter lesions, and large fluffy brainstem
lesions, and leptomeningeal
enhancement may be encountered 

Optic nerve lesions with MOG-IgG–associated
disorder tend to be longitudinally extensive
and often involve the anterior optic pathway,
sparing the chiasm2.

 

 

 


 

                                                    
                                                                   COMPARISON OF MOG, NMO AND MS

               AXIAL T2 (NON CONTRAST)

              AXIAL CONTRAST

MOG: Sagittal T2-hyperintense line (white arrowhead) surrounded by hazier T2 hyperintensity (yellow arrowheads)
On axial sequences, the T2 hyperintensity is highly restricted to the gray matter forming an H sign (red arrowhead).
Postgadolinium sagittal images demonstrate no gadolinium enhancement.

NMO: Hyperintense extensive lesion with prominent swelling (yellow arrowheads) and axial T2  lesion with diffuse central signal
abnormality not confined to gray matter (red arrowhead).

MS: Short T2-hyperintense lesion at the C2 level extending one vertebral segment in length  (yellow arrowhead) with 
accompanying faint ring enhancement (blue arrowhead). 
On axial sequences, the lesion is located in the periphery of the cord in the right dorsal column  (red arrowhead).

Central (Gray White Matter) forming an
 pattern.
(TIE fighter appearance)

Faint or no enhancement2


 


                            From: Ref 2

References

1.          Dubey D, Pittock SJ, Krecke KN, et al. Clinical, Radiologic, and Prognostic Features of Myelitis Associated with Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA Neurol 2019;76(3):301–9.

2.          Lopez Chiriboga S, Flanagan EP. Myelitis and Other Autoimmune Myelopathies. Contin Lifelong Learn Neurol 2021;27(1):62–92.