The usefulness of brain MRI at onset in the differentiation of multiple sclerosis and seropositive neuromyelitis optica spectrum disorders.
BACKGROUND
Although neuromyelitis optica (NMO) is a central nervous system (CNS) autoimmune disease distinct from multiple sclerosis (MS). NMO and NMO spectrum disorder (NMOSD) sometimes show asymptomatic lesions on brain magnetic resonance imaging (MRI) at onset, and even present with symptomatic brain involvement.


OBJECTIVE
We investigated whether brain MRI at onset can be helpful for the differentiation of MS and NMOSD.


METHODS
We retrospectively analyzed initial brain MRIs, performed within three months of onset, in patients with MS (n = 51) and anti-aquaporin4-antibody-positive patients with NMOSD (n = 67).


RESULTS
NMOSD patients met the Paty (37%) and Barkhof (13%) criteria, and the criteria of the European Magnetic Imaging in MS (MAGNIMS) study group (9%), for MS. Ovoid lesions perpendicular to the lateral ventricle, isolated juxtacortical lesions in U-fibers and isolated ovoid/round cortical lesions were found only in MS patients, whereas longitudinal corticospinal tract lesions, extensive hemispheric lesions, periependymal lesions surrounding the lateral ventricle and cervicomedullary lesions were found only in NMOSD patients.


CONCLUSIONS
Our study suggests that it is difficult to differentiate MS from NMOSD by the fulfillment of the MRI criteria for MS on brain MRI at onset; however, the characteristic morphology of brain lesions is highly useful for the early differentiation of the two disorders.
Department of Neurology, Kosin University College of Medicine, Kosin University Gospel Hospital and Department of Neurology, National Cancer Center, Korea.
So-Young
SY
Huh
Ju-Hong
JH
Min
Woojun
W
Kim
Su-Hyun
SH
Kim
Ho Jin
HJ
Kim
Byung-Jo
BJ
Kim
Byoung Joon
BJ
Kim
Kwang Ho
KH
Lee
D000328:Adult; D051401:Aquaporin 4 / Q000276:immunology; D001323:Autoantibodies / Q000378:metabolism; D001921:Brain / Q000276:immunology / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D009471:Neuromyelitis Optica / Q000175:diagnosis* / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult
D051401:Aquaporin 4; D001323:Autoantibodies
MRI; Neuromyelitis optica; aquaporin-4; brain; multiple sclerosis; onset