Myelopathy

American Journal of Neuroradiology

Clinical condition: myelopathy

	CT spine without contrast	CT spine with contrast	CT myelography	MRI spine without contrast	MRI spine without and with contrast	X-ray spine	X-ray myelography	CTA spine	MRA spine
Traumatic	9^a	2	5^b	8^c ^d	2	7^e ^f	3^g	3^h	3^h
Painful^*	7ⁱ	3^j	5^k	8	7^l	3^f	2^g	2^c	2
Sudden onset^†	5^k	3	6^k	9	8	3^f	6^g	5^m	4^m
Stepwise progressive^‡	5^k	3	6^k	9	8	3	6^g ^m	5	4
Slowly progressive^§	6ⁱ	3^j	5^k	8	7	3^f	5^g ⁿ	2	2
Infectious disease patient^‖	6^k	5	5^k	8	9	3^f	5^g ^k	2	2
Oncology patient^¶	6^k	4	5^k	9	8	3^o	5^g ^k	2^c	2

Note:—Rating Scale: 1, least appropriate; 9, most appropriate.
^a First test for acute management.
^b MRI preferable.
^c Problem solving or operative planning.
^d Most useful when injury not explained by bony fracture.
^e May be first test in multi-symptom trauma, especially when CT is delayed.
^f To assess stability.
^g Usually performed in conjunction with CT.
^h For suspected vascular trauma.
ⁱ Most useful for spondylosis.
^j Consider for infection, neoplasm or if MRI unavailable or contraindicated.
^k Problem solving or if MRI unavailable or contraindicated.
^l If infection or neoplastic disorder suspected.
^m If AVM is suspected.
ⁿ If MRI is not possible or for preoperative planning and problem solving.
^o Assess stability or for treatment planning.
* Bone scan, rating of 4 to search for associated extra spinal disease.
† Arteriography spine, rating of 4 if AVM suspected.
‡ Arteriography spine, rating of 6 if AVM suspected.
§ Bone scan, rating of 4 and arteriography spine, rating of 4.
‖ WBC scan rating of 4 may be combined with bone scan to diagnose osteomyelitis.
¶ Bone scan, rating of 6 to search for associated extra spinal disease.