Version May 2024
| Spinal cord MRI, acute |
| LETM lesion associated with acute TM |
| Increased signal on sagittal T2-weighted (standard T2-weighted, proton density, or STIR sequences) extending over three or more complete vertebral segments |
| Central cord predominance (more than 70% of the lesion residing within the central gray matter) |
| Gadolinium enhancement of the lesion on T1-weighted sequences (no specific distribution or pattern of enhancement is required) |
| Other characteristic features that may be detected |
| Rostral extension of the lesion into the brainstem |
| Cord expansion/swelling |
| Decreased signal on T1-weighted sequences corresponding to region of increased T2-weighted signal |
| Spinal cord MRI, chronic |
| Longitudinally extensive cord atrophy (sharply demarcated atrophy extending over ≥3 complete, contiguous vertebral segments and caudal to a particular segment of the spinal cord), with or without focal or diffuse T2 signal change involving the atrophic segment |
| Optic nerve MRI |
| Unilateral or bilateral increased T2 signal or T1 gadolinium enhancement within optic nerve or optic chiasm; relatively long lesions (eg, those extending more than half the distance from orbit to chiasm) and those involving the posterior aspects of the optic nerves or the chiasm are associated with NMO |
| Cerebral MRI: NMOSD-typical brain lesion patterns (increased signal on T2-weighted MRI sequences unless otherwise noted) |
| Lesions involving the dorsal medulla (especially the area postrema), either small and localized, often bilateral, or contiguous with an upper cervical spinal cord lesion |
| Periependymal surfaces of the fourth ventricle in the brainstem/cerebellum |
| Lesions involving the hypothalamus, thalamus, or periependymal surfaces of the third ventricle |
| Large, confluent, unilateral, or bilateral subcortical or deep white matter lesions |
| Long (one-half of the length of the corpus callosum or greater), diffuse, heterogeneous, or edematous corpus callosum lesions |
| Long corticospinal tract lesions, unilateral or bilateral, contiguously involving internal capsule and cerebral peduncle |
| Extensive periependymal brain lesions, often with gadolinium enhancement |
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