Bright spotty lesions, also known as brighter spotty lesions, are a radiographic sign typically seen in, and very specific for, acute myelitis due to neuromyelitis optica spectrum disorder (NMOSD).
Bright spotty lesions are defined as intramedullary lesions of the spinal cord that are T2 hyperintense relative to surrounding cerebrospinal fluid (CSF), as seen on either axial or sagittal MRI views 1-6. Bright spotty lesions are also often T1 hypointense relative to the cord grey matter 1-6. An expanded definition suggests that bright spotty lesions can also include spinal cord lesions that are T2 isointense relative to CSF and T1 hyperintense relative to CSF, but still generally T1 hypointense relative to cord grey matter 1,5.
The radiographic finding of bright spotty lesions in a patient presenting with acute myelitis is very specific (~90-100%) for neuromyelitis optica spectrum disorder (NMOSD), but not as sensitive (~30-70%) 1. Thus, presence of bright spotty lesions has been found to be a useful radiographic marker in differentiating myelitis due to neuromyelitis optica spectrum disorder (NMOSD) from other conditions that cause myelitis or a myelitis-like appearance but where bright spotty lesions are rarely seen, including multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), idiopathic transverse myelitis, and spinal cord infarction 1,3-6.
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