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Radiologie up2date 2022; 22(02): 137-155
DOI: 10.1055/a-1718-8874
Neuroradiologie

Differenzialdiagnose der zervikalen Myelitis

Differential Diagnosis of Cervical Myelopathies
Stefan Weidauer
,
Christophe Arendt
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Zusammenfassung

Die breite Differenzialdiagnose intradural bedingter zervikaler Myelopathien umfasst neben entzündlichen und infektiösen Ursachen auch vaskuläre, metabolische, neoplastische und hereditär degenerative Erkrankungen. Die spinale Bildgebung hat daher auch im Hinblick auf eine frühzeitige und zielgerichtete Therapie eine zentrale Stellung. In dieser Übersichtsarbeit werden typische Krankheitsbilder und Differenzialdiagnosen dargestellt.

Abstract

The broad differential diagnosis of intradural cervical myelopathies includes inflammatory and infectious etiologies as well as vascular, metabolic, neoplastic and hereditary degenerative diseases. Therefore, spinal imaging has a central importance also with regard to early and targeted therapy. In this review, typical clinical features are presented and strategies for differential diagnosis are provided on the basis of characteristic lesion patterns and indicative neuroradiological findings.

Kernaussagen

  • Klinisch-neurologisch werden eine akute transverse (ATM) und eine akute partiell transverse (APTM) Myelitis unterschieden.

  • Die APTM mit einer longitudinalen Ausdehnung kleiner 2 WK-Höhen stellt häufig die Ouvertüre einer MS dar.

  • MS-assoziierte spinale Läsionen sind häufig ovalär und kurzstreckig und liegen peripher mit Kontakt zum Liquorraum.

  • Hilfreich für die Differenzierung von Myelitiden sind folgende Läsionsmuster:

    • langstreckig (LETM)

    • kurzstreckig, ovoid oder peripher lokalisiert

    • Poliomyelitis-ähnlich

    • granulomatös

  • Die longitudinale Ausdehnung über 3 WK (LETM), eine Signalabsenkung auf den T1w Aufnahmen und eine betont zentrale Myelonaffektion sind richtungweisend für eine NMOSD.

  • Wichtig ist die Untersuchung von AQP4-, MOG- und GFAP-AK für die weitere Differenzierung autoimmun vermittelter Myelitiden.

  • Essenziell ist die ergänzende zerebrale Bildgebung bei Myelitiden.

  • Die heterogene Ätiopathogenese nicht entzündlicher Myelopathien umfasst vaskuläre, metabolische, neoplastische und hereditär degenerative Erkrankungen.

  • Perimedulläre „flow voids“ sind typisch für eine durale AV-Fistel und eine spinale AVM.

Schlüsselwörter

Myelopathie - akute transverse Myelitis - akute partielle transverse Myelitis - longitudinal extensive transverse Myelitis - kurzstreckige Myelitis - Neuromyelitis-optica-Spektrum-Erkrankung

Key words

myelopathy - acute transverse myelitis - acute partial transverse myelitis - longitudinally extensive transverse myelitis - short transverse myelitis - Neuromyelitis optica spectrum disorders


Publication History

Article published online:
02 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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