MRI Predictors of Recurrence and Outcome after Acute Transverse Myelitis of Unidentified Etiology

Abstract

BACKGROUND AND PURPOSE: The early prediction of recurrence after an initial event of transverse myelitis helps to guide preventive treatment and optimize outcomes. Our aim was to identify MR imaging findings predictive of relapse and poor outcome in patients with acute transverse myelitis of unidentified etiology. MATERIALS AND METHODS: Spinal MRIs of 77 patients (mean age, 36.3 Ϯ 20 years) diagnosed with acute transverse myelitis were evaluated retrospectively. Only the patients for whom an underlying cause of myelitis could not be identified within 3 months of symptom onset were included. Initial spinal MR images of patients were examined in terms of lesion extent, location and distribution, brain stem extension, cord expansion, T1 signal, contrast enhancement, and the presence of bright spotty lesions and the owl's eyes sign. The relapse rates and Kurtzke Expanded Disability Status Scale scores at least 1 year (range, 1-14 years) after a myelitis attack were also recorded. Associations of MR imaging findings with clinical variables were studied with univariate associations and binary log-linear regression. Differences were considered significant for P values Ͻ .05. RESULTS: Twenty-seven patients (35.1%) eventually developed recurrent disease. Binary logistic regression revealed 3 main significant predictors of recurrence: cord expansion (OR, 5.30; 95% CI, 1.33-21.11), contrast enhancement (OR, 5.05; 95% CI, 1.25-20.34), and bright spotty lesions (OR, 3.63; 95% CI, 1.06-12.43). None of the imaging variables showed significant correlation with the disability scores. CONCLUSIONS: Cord expansion, contrast enhancement, and the presence of bright spotty lesions could be used as early MR imaging predictors of relapse in patients with acute transverse myelitis of unidentified etiology. Collaborative studies with a larger number of patients are required to validate these findings.

Non-traumatic acute myelopathies: Clinical and imaging features in a real world emergency setting

“…The few published articles were mainly focused on inflammatory or idiopathic myelitis, spinal infarction or compression. 14,22,[29][30][31] Moreover, to our best knowledge, only another study explored the early clinical presentation of AMs in the emergency setting. 22 Another…”

“…The few published articles were mainly focused on inflammatory or idiopathic myelitis, spinal infarction or compression. 14,22,29–31 Moreover, to our best knowledge, only another study explored the early clinical presentation of AMs in the emergency setting. 22 Another strength of the present study is the adoption of a standardized MRI protocol and homogeneous diagnostic work-up to affirm the final diagnosis according to the most recent international guidelines or expert recommendations.…”

Hình Ảnh Cộng Hưởng Từ Bệnh Viêm Tủy Cắt Ngang Cấp Ở Trẻ Em

“…1 Cộng hưởng từ (CHT) là phương pháp có độ chính xác cao nhất trong chẩn đoán bệnh viêm tủy, xác định vị trí, mức độ lan rộng của tổn thương giúp bác sỹ lâm sàng định hướng chẩn đoán, tiên lượng bệnh, có kế hoạch theo dõi lâu dài. 2 Hiện nay tại Việt Nam chưa có nhiều nghiên cứu về bệnh viêm tủy cắt ngang ở trẻ em, đặc biệt là nghiên cứu về hình ảnh CHT. Do đó chúng tôi tiến hành nghiên cứu "Hình ảnh cộng hưởng từ bệnh viêm tủy cắt ngang cấp ở trẻ em" với mục đích hỗ trợ chẩn đoán sớm, nhằm nâng cao kết quả điều trị, góp phần cải thiện tiên lượng lâu dài của bệnh nhân.…”

“…Đã có báo cáo cho thấy tổn thương kéo dài đến thân não tiến triển thành viêm tủy thị thần kinh về sau. 2 Bảng 2 cho thấy tổn thương tủy kéo dài trung bình 8,1±5,5 đốt sống, trong đó có đến 91,5% tổn thương tủy từ 3 đốt sống trở lên (LEMT). Trong nghiên cứu của Alper và cộng sự (2011), 67% bệnh nhân có tổn thương LEMT.…”

Oxymorons in medical imaging flip-flops, longitudinally-transverse

“…In cases of idiopathic transverse myelitis, the presence of cord expansion with bright spotty lesions, with the appearance of enhancement, are early MRI markers for increased risk of relapse. [ 5 ]…”