LUPUS-RELATED MYELITIS - SERIAL MR FINDINGS

PURPOSE: To correlate the MR findings in transverse myelitis secondary to systemic lupus erythematosus with clinical findings during disease exacerbation and remission. METHODS: Four patients (ages 33 to 47 yea rs) with episodes of transverse myelitis secondary to systemic lupus e rythematosus were identified. Three patients had recurrent transverse myelitis episodes (one patient with two recurrences), for a total of e ight episodes. MR examinations (six after contrast administration) wer e performed during each transverse myelitis episode, as well as during four periods of remission (in three patients) after therapy with ster oids and/or immunosuppressive agents. MR examinations were reviewed fo r the presence of spinal cord enlargement, intramedullary signal abnor mality, and contrast enhancement. RESULTS: Prolongation of T1 or T2 si gnal (or both) was seen in eight episodes (100%). Spinal cord enlargem ent was seen in six (75%) of eight transverse myelitis episodes, altho ugh it was mild during two episodes. Contrast enhancement was seen in three of six transverse myelitis episodes (dense, inhomogeneous enhanc ement during two episodes in one patient, and a small focus of enhance ment in one patient). During periods of remission, spinal cord diamete r returned to normal, and no contrast enhancement was seen, although a bnormal signal was present in three examinations performed within 2 mo nths of a transverse myelitis episode. CONCLUSION: Spinal cord widenin g and signal abnormalities are common MR findings during episodes of t ransverse myelitis related to systemic lupus erythematosus, and contra st enhancement is less frequently seen. Improvement or resolution of t hese findings correlates with clinical improvement.