MRI Spine — myelitis / inflammatory cord disease
Whole cord from the craniocervical junction to the conus, with axial sections through every abnormal segment.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Suspected transverse myelitis or an acute cord syndrome without a compressive cause.
- First presentation of suspected demyelination with cord symptoms, to establish dissemination in space alongside the brain study.
- Suspected neuromyelitis optica spectrum disorder or MOG-associated disease, where longitudinally extensive cord lesions are the discriminator.
- Known multiple sclerosis with new cord symptoms.
- Suspected cord involvement by sarcoidosis or other granulomatous disease.
Technique
- Sagittal T2 and sagittal STIR or proton-density through the whole cord, with axial T2 through abnormal segments to establish the cross-sectional pattern.
- Thin axial sections are essential: lesion location within the cord cross-section is a major discriminator and cannot be judged from sagittals.
- Post-contrast sagittal and axial T1 to establish activity.
- A brain study is usually acquired in the same sitting because the diagnostic criteria depend on both compartments.
Where it goes wrong
- Sagittal-only imaging, which cannot characterise a cord lesion.
- Cerebrospinal fluid pulsation artefact in the thoracic cord mimicking an intramedullary lesion.
- Coverage stopping above the conus and missing a conus lesion.
- Slice thickness too great for a small cord lesion, particularly in the cervical region.
- Not obtaining the brain study, leaving the dissemination question unanswerable.
Clinical questions that reach this study
Suspected multiple sclerosis or first demyelinating eventSuspected metastatic spinal cord compressionSuspected cauda equina syndromeSuspected discitis, vertebral osteomyelitis or epidural abscessLow back pain without red flagsSuspected inflammatory spinal cord lesion (transverse myelitis)Thoracic back pain and suspected thoracic myelopathyThoracolumbar spine traumaSuspected myeloma — skeletal assessmentSuspected bone metastases
Contrast
Gadolinium, intravenous
Macrocyclic gadolinium agent at a typical single dose of about 0.1 mmol/kg; post-contrast sagittal and axial T1 through the abnormal segment.
Acquisition
- Breathing
- Free breathing; cardiac or respiratory gating is sometimes used to reduce cerebrospinal fluid pulsation artefact.
- Preparation
- For suspected MSCC state neurological findings and time of onset — this is a same-day pathway, not a routine list slot. Analgesia and positioning support should be arranged in advance; an incomplete study because the patient could not lie flat is a failed study. Gadolinium is not needed to answer the compression question and is added only for infection, inflammation or when a soft-tissue mass needs characterising.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- MR safety screening for implants and foreign bodies· radiographer at scan