title: Distinct lesion morphology at 7-T MRI differentiates neuromyelitis optica from multiple sclerosis.
abstract: OBJECTIVE
  To investigate distinct white matter and cortical gray matter pathology in neuromyelitis optica spectrum disorders (NMOSDs) and multiple sclerosis (MS) at 7-T MRI in a cross-sectional study.
  
  
  METHODS
  We included 10 patients with NMOSDs and 18 patients with MS in our 7-T MRI study. The imaging protocol comprised T2*-weighted fast low angle shot and turbo inversion recovery magnitude sequences. White matter and cortical gray matter lesions were assessed with special regard to their (perivascular) localization as well as the expression of a hypointense rim.
  
  
  RESULTS
  In total, we detected 140 white matter lesions in 7 of 10 patients with NMOSDs. In contrast to MS plaques, which were nearly exclusively centered by a small vein (92%) and showed a characteristic hypointense rim (23%), white matter changes in patients with NMOSDs were nonspecific in appearance and were only infrequently neighbored by a blood vessel (49 lesions [35%], p = 0.003). Hypointense rims were very rarely detectable (3 lesions [2%], p < 0.001). Cortical pathology was absent in NMOSDs. In our MS cohort, we detected 36 leukocortical, 8 intracortical, and 8 subpial cortical lesions in 7 of 18 patients.
  
  
  CONCLUSIONS
  The MRI features of white matter and the absence of cortical gray matter findings substantially differentiate NMOSDs from MS and can be used as a potential marker to distinguish these 2 entities. The fact that cortical pathology is common in MS but is not present in patients with NMOSDs may reflect the difference in the underlying pathogenesis.
authors.affiliation: NeuroCure Clinical Research Center, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Sinnecker
authors.forename: Jan
authors.initials: J
authors.lastname: Dörr
authors.forename: Caspar F
authors.initials: CF
authors.lastname: Pfueller
authors.forename: Lutz
authors.initials: L
authors.lastname: Harms
authors.forename: Klemens
authors.initials: K
authors.lastname: Ruprecht
authors.forename: Sven
authors.initials: S
authors.lastname: Jarius
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Brück
authors.forename: Thoralf
authors.initials: T
authors.lastname: Niendorf
authors.forename: Jens
authors.initials: J
authors.lastname: Wuerfel
authors.forename: Friedemann
authors.initials: F
authors.lastname: Paul
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009471:Neuromyelitis Optica / Q000473:pathology*; D011446:Prospective Studies