Does the lack of enhancement essentially exclude a tumour?
It was thought that this was the case some time ago, but it is increasingly evident that a minority (anything up to 15%) of tumours (especially astrocytomas) do not demonstrate convincing enhancement.
Given the relatively short duration of symptoms, what other process (other than neoplasm) should be considered?
Transverse myelitis should be very high on the list.
If enhancement was present would it essentially exclude transverse myelitis?
Absolutely not. Enhancement is frequently present and is variable.
How can the possibility of this representing transverse myelitis be further investigated?
Lumbar puncture demonstrating CSF pleocytosis or increased IgG index.
The lower thoracic cord from T10 to T12 is expanded and demonstrates an ill-defined T2 hyperintensity in two segments. At the level of the upper portion of T10 there is a ventral and then almost complete but mainly right-sided expansion and T2 signal change. It is isointense on T1. This ends at the lower half of the T11 vertebral body but there is a second area of involvement behind the T12 vertebral body extending down to the conus at the T12/L1 disc level. No contrast enhancement is present.
The abnormality involves the intramedullary cord with no abnormality of the extra dural space. No flow-voids or vascular anomalies are noted. No blood products are present within or outside the cord.There is an incidental haemangioma in the vertebral body of T6.