Background

Compressive myelopathy secondary to degenerative disc disease is frequently encountered by neuroradiologists. MRI is used for identification and characterisation of cord abnormalities in patients with clinically suspected myelopathy. While there are classical imaging features described, compressive myelopathy may pose a diagnostic challenge to the reporting radiologist, particularly in the presence of post-contrast enhancement, where appearances may mimic neoplastic, inflammatory and/or immune-mediated pathologies.

Objective

In our case series, we show different imaging findings in compressive myelopathy including post-contrast enhancement patterns, temporal evolution/resolution of enhancing lesions as well as appearances of compressive myelopathy on diffusion weighted imaging and diffusion tensor imaging.

Methods

Retrospective collection of cases, which have been followed up with serial MRI studies confirming the diagnosis of compressive myelopathy-related intramedullary enhancement. All patients presented with myelopathic symptoms. In view of the clinical and radiological differential diagnoses, the patients selected underwent contrast-enhanced imaging to further characterise the areas of signal abnormality.

Results

Contrast enhancement patterns were established with assessment of temporal evolution in lesions, in all patients included in the case series.

Conclusions

We present a pictorial review of imaging patterns in compressive myelopathy, with particular focus on enhancement patterns following the administration of intravenous gadolinium.