Benign longitudinal T2-hyperintense signal in the lateral cord in infancy: a cross-sectional study of spinal cord white matter maturation on magnetic resonance imaging

Abstract

Longitudinal T2-hyperintense signal is commonly seen in the spinal cord of infants and likely reflects normal unmyelinated white matter tracts, but it can be mistaken for pathology. Autopsy studies have described incomplete myelination of spinal cord in early childhood; however, the maturation timeline of the spinal cord has not been described on imaging. The purpose of this study was to retrospectively evaluate the maturation timeline of the spinal cord on MRI to provide a baseline for image interpretation. We retrospectively reviewed axial T2-W images of the spinal cord acquired on 1.5-tesla (T) and 3.0-T MRI in children ages 0–2 years for presence of longitudinal T2-hyperintense signal, and we subjectively graded this signal as 0 (absent) to 3 (pronounced). Further, we reviewed a summary of medical records for confounding pathology in the brain or spine. Cord signal was interpreted as normal in the clinical report by subspecialized pediatric neuroradiologists for all included children. We reviewed 437 MRI exams from 409 children and included 189 studies in the analysis. Longitudinal T2-hyperintense signal in the lateral cord was seen in 95% (19/20) of subjects <1 month of age and was not seen in subjects ages 21–24 months (0/15). Grade 3 signal was seen in 22% (11/50) of infants ages 0–2 months and was not seen infants older than 5 months. Characteristic symmetrical longitudinal T2 hyperintensity in the lateral spinal cord is common in infants and should not be mistaken for pathology, and it was not seen in children older than 21 months.