What cord feature on MRI is commonly seen in cervical myelopathy?

• A. Anterior cord atrophy
• B. Intramedullary T2 hyperintensity with canal stenosis
• C. Posterior cord compression without signal change
• D. Diffuse cord edema

Answer: (B)

Cervical myelopathy from compression classically shows intramedullary T2-weighted hyperintensity within the spinal cord at the level of canal stenosis. This T2 signal change reflects cord edema, demyelination, or gliosis from chronic injury due to the narrowed canal. Seeing both the narrowed canal and the focal intramedullary hyperintensity ties the mechanical compression to the resulting cord pathology, making this the most characteristic and clinically meaningful MRI finding.

Other patterns are less typical for this condition. Anterior cord atrophy can occur with long-standing damage but does not by itself indicate the active myelopathic signal change. Posterior cord compression without signal change suggests compression without cord injury evidence. Diffuse cord edema can occur in various settings but lacks the classic focal intramedullary signal change aligned with canal stenosis seen in cervical myelopathy.