Neuromyelitis optica (NMO): spinal radiological features

Evidence-based neurology checklist on neuromyelitis optica (nmo): spinal radiological features: Longitudinally extensive transverse myelitis (LETM) This is a central cord lesion with oedema and enhancement The lesion is usually complete and severe It often involves the cervico-medullary junction…

Longitudinally extensive transverse myelitis (LETM)

  • This is a central cord lesion with oedema and enhancement
  • The lesion is usually complete and severe
  • It often involves the cervico-medullary junction
  • There is a cord expansion ratio of >1.4
  • It is double-contoured
  • It demonstrates dorsal subpial enhancement

Bright spotty lesions (BSLs)

Short segment transverse myelitis (STM)

Spinal cord atrophy

Other spinal features

References

  1. Matthews L, Kolind S, Brazier A, et al. Imaging surrogates of disease activity in neuromyelitis optica allow distinction from multiple sclerosis. PLoS One 2015; 10:e0137715. 
  2. Chee CG, Park KS, Lee JW, Ahn HW, Lee E, Kang Y, Kang HS. MRI features of aquaporin-4 antibody-positive longitudinally extensive transverse myelitis: insights into the diagnosis of neuromyelitis optica spectrum disorders. Am J Neuroradiol 2018; 39:782-787.
  3. Sukhonpanich N, Ngamsombat C, Buathong S, et al. Diagnostic utility of novel and established spinal MRI Signs in AQP4-IgG-seropositive NMOSD myelitis. Neurology 2026; 107:e218507.
  4. Yonezu T, Ito S, Mori M, Ogawa Y, Makino T, Uzawa A, Kuwabara S. "Bright spotty lesions" on spinal magnetic resonance imaging differentiate neuromyelitis optica from multiple sclerosis. Mult Scler 2014; 20:331-337. 
  5. Flanagan EP, Kaufmann TJ, Krecke KN, et al. Discriminating long myelitis of neuromyelitis optica from sarcoidosis. Ann Neurol 2016; 79:437-447. 
  6. And 7 more. Subscribe to see the full list

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