Female, 29 years old, T3-T6 myelitis. T2 hyperintensity is evident within the spinal cord beginning at the T1-2 disc level and continuing down to the T9-10 disc level. Signal abnormality appears to affect the central cord more than the peripheral cord, but the cord is not significantly expanded. At the T5-6 level, there is a 7 mm focus of enhancement within the cord. Diffusion-weighted imaging shows mild hyperintensity within the upper thoracic cord, though this is difficult to interpret as the ADC map does not fully corroborate the DWI signal.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow enhancement is seen. The intervertebral discs are preserved with no significant bulge or herniation. The spinal canal and neural foramina are patent. Prominent dorsal epidural fat is noted which causes narrowing of the thecal sac through much of the thoracic spine.
Central spinal cord signal abnormality is seen from T1-2 down to T9-10. Patchy enhancement is evident at the T5-6 level, though the majority of this abnormality does not enhance. Diffusion and ADC findings are difficult to interpret and should probably not be relied upon. As such, the differential diagnosis remains broad and would include infection, post infectious or autoimmune myelitis, demyelinating disease and ischemia.