Magnetic Resonance Imaging (MRI) of the cervical spine illustrating a diagnostic view of transverse myelitis. Image (a) is a sagittal T2-weighted sequence showing extensive, longitudinal intramedullary hyperintensity within the spinal cord extending from the C2 to C7 levels, marked by white arrows. This indicates significant edema or inflammation without significant cord expansion. Images (b), (c), and (d) provide axial T2-weighted cross-sections at the C3-C4, C4-C5, and C5-C6 levels respectively. These axial views demonstrate a central, bright signal change within the cord parenchyma that appears hyperintense relative to normal cord tissue and is similar in intensity to the surrounding cerebrospinal fluid (CSF). There is mild evidence of spinal canal stenosis, but the primary pathology is the centrally located, diffuse signal abnormality. The findings are characteristic of longitudinal extensive transverse myelitis (LETM), often used in the differential diagnosis of neuroinflammatory conditions such as Neuromyelitis Optica (NMO) or multiple sclerosis.

This diagnostic comparison chart displays four T2-weighted magnetic resonance imaging (MRI) scans of the spinal cord, illustrating Idiopathic Acute Transverse Myelitis (IATM). The image is organized into a 2x2 grid comparing MRI-positive and MRI-negative patients across sagittal and axial planes. In the MRI-positive sagittal view of the cervical spine, a distinct longitudinal area of hyperintense (bright) signal is visible within the spinal cord, indicating inflammation or edema characteristic of active transverse myelitis. The corresponding axial image confirms centrally located high signal intensity within the cord. In contrast, the MRI-negative sagittal and axial views show a spinal cord with normal morphology and uniform, low-to-intermediate signal intensity, demonstrating a clinical scenario where diagnostic criteria for IATM are met (e.g., via CSF analysis or clinical symptoms) despite unremarkable imaging. These images serve as educational examples for neuroradiology and neurology to differentiate between visible inflammatory lesions and MRI-negative clinical presentations of spinal cord disorders.

This diagnostic image set consists of MRI scans of the thoracic spine illustrating transverse myelitis. Panels A and B are sagittal T2-weighted images showing longitudinally extensive high signal intensity within the spinal cord, specifically spanning the T5-T7 and T10-T12 vertebral levels. These areas of hyperintensity are accompanied by mild cord swelling and enlargement, characteristic of inflammatory edema. Panel C presents a sagittal T1-weighted post-contrast image demonstrating focal enhancement within the affected cord segments, indicating a breach in the blood-spinal cord barrier. Panel D provides an axial view confirming the intramedullary location of the high signal intensity, which involves a significant cross-sectional area of the cord. These findings are clinically significant for diagnosing inflammatory or infectious myelopathies, such as spinal toxocariasis or idiopathic transverse myelitis, by identifying the extent of cord involvement and the presence of active inflammation through gadolinium enhancement.

This series of five T2-weighted sagittal MRI images (labeled A through E) illustrates the longitudinal progression and treatment response of transverse myelitis in the thoracic spine. Image A serves as a baseline, showing normal spinal cord signal intensity without lesions. Image B demonstrates the emergence of increased intramedullary T2 signal intensity (hyperintensity) localized near the T7 vertebral level, indicative of early cord changes. Image C reveals significant cephalad extension (ascending) of the lesion, with a white arrow marking the superior border of the transverse myelitis, which now spans multiple vertebral segments. Images D and E show sequential follow-up after the initiation of immunotherapy (infliximab). Image D displays a marked reduction in the longitudinal extent and intensity of the T2 signal abnormality, suggesting a positive therapeutic response. Image E demonstrates a stable but persistent area of mild hyperintensity near T7, reflecting residual cord changes. This radiographic series is a classic educational example of immune-mediated or radiation-induced myelopathy and its monitoring through MRI imaging.