Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Transverse myelitis CT scan
Introduction
Overview
Overview
- Computed tomography (CT) is not the diagnostic study of choice for transverse myelitis and cannot confirm or exclude inflammation of the spinal cord.
- Routine CT of the spine has limited soft-tissue contrast for evaluating intramedullary spinal-cord abnormalities. Its principal value is identifying selected osseous or extra-axial abnormalities that may cause spinal cord compression.
- The Transverse Myelitis Consortium Working Group diagnostic criteria require exclusion of an extra-axial compressive cause by magnetic resonance imaging or myelography and specify that routine spinal CT alone is not adequate for this purpose.[1]
- The 2026 American College of Radiology (ACR) Appropriateness Criteria identify magnetic resonance imaging (MRI) as the preferred initial examination for acute myelopathy. CT and CT myelography are reserved for selected clinical circumstances and must not be interpreted as disease-specific tests for transverse myelitis.[2]
Role of computed tomography
Role of computed tomography
| Examination | Evidence-based role and interpretation |
|---|---|
| Routine spinal CT without intravenous contrast | May demonstrate vertebral fracture, destructive osseous disease, calcification or ossification, marked degenerative stenosis, or gross compromise of the spinal canal. It does not reliably demonstrate inflammatory lesions within the spinal cord and is not adequate by itself to exclude a compressive cause under the consensus diagnostic criteria for transverse myelitis.[1][2] |
| Spinal CT with intravenous contrast | May provide additional information when a specific enhancing extra-axial, infectious, or neoplastic abnormality is suspected and MRI cannot be performed. There is no characteristic contrast-enhanced CT appearance that confirms transverse myelitis.[2] |
| CT myelography | CT myelography uses intrathecal iodinated contrast material administered during lumbar puncture to outline the subarachnoid space, thecal sac, spinal cord, and nerve roots. It may be considered when MRI is contraindicated, unavailable, or nondiagnostic and urgent evaluation for an extra-axial compressive lesion is required. CT myelography can demonstrate the level and degree of spinal-canal obstruction or cord displacement, but it does not directly confirm inflammatory myelitis.[1][2] |
| Normal CT or CT myelogram | A normal examination does not exclude transverse myelitis because CT-based examinations may not demonstrate an intramedullary inflammatory lesion. The diagnosis still requires the appropriate clinical syndrome and evidence of spinal-cord inflammation according to the applicable diagnostic criteria.[1] |
When computed tomography may be considered
When computed tomography may be considered
CT-based imaging may be considered in selected patients when:
- MRI cannot be performed safely or promptly, or is nondiagnostic, and a compressive lesion must be urgently assessed.[2]
- Detailed evaluation of osseous anatomy, calcification, ossification, fracture, or severe degenerative narrowing is clinically necessary.[2]
- CT myelography is required to evaluate the spinal canal and thecal sac after consultation with a radiologist or relevant specialist.[2]
Clinical interpretation
Clinical interpretation
- There is no CT finding that is confirmatory of transverse myelitis.
- Routine CT of the spine must not be used as a substitute for MRI or CT myelography when exclusion of an extra-axial compressive lesion is required.[1]
- Detection of a compressive lesion, fracture, destructive osseous abnormality, or other structural cause should redirect evaluation and management away from primary inflammatory transverse myelitis.
- A negative CT examination must not delay further spinal-cord evaluation when the clinical findings remain consistent with acute myelopathy.
- CT myelography is invasive and involves ionizing radiation, lumbar puncture, and intrathecal iodinated contrast; it should therefore be reserved for appropriately selected patients.[2]
References
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002;59(4):499-505. Digital object identifier: 10.1212/WNL.59.4.499. PubMed identifier: 12236201.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 American College of Radiology (ACR) Expert Panel on Neurological Imaging; Peckham M, Hutchins TA, Amrhein TJ, et al. ACR Appropriateness Criteria® Myelopathy: 2026 Update. Journal of the American College of Radiology. 2026;23(9):1870-1883. Digital object identifier: 10.1016/j.jacr.2026.06.003. PubMed identifier: 42340276.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Julinka Auta Fernandes