title: Comparison between the cranial magnetic resonance imaging features of neuromyelitis optica spectrum disorder versus multiple sclerosis in Taiwanese patients.
abstract: BACKGROUND
  Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the central nervous system with different pathogenesis, brain lesion patterns, and treatment strategies. However, it is still difficult to distinguish these two disease entities by neuroimaging studies. Herein, we attempt to differentiate NMOSD from MS by comparing brain lesion patterns on magnetic resonance imaging (MRI).
  
  
  METHODS
  The medical records and cranial MRI studies of patients with NMOSD diagnosed according to the 2006 Wingerchuk criteria and the presence of anti-aquaporin 4 (anti-AQP4) antibodies, and patients with MS diagnosed according to the Poser criteria, were retrospectively reviewed.
  
  
  RESULTS
  Twenty-five NMOSD and 29 MS patients were recruited. The NMOSD patients became wheelchair dependent earlier than MS patients (log rank test; P = 0.036). Linear ependymal (28% vs. 0%, P = 0.003) and punctate lesions (64% vs. 28%, P = 0.013) were more frequently seen in NMOSD patients. Ten NMOSD patients (40%) had brain lesions that did not meet the Matthews criteria (MS were separated from NMOSD by the presence of at least 1 lesion adjacent to the body of the lateral ventricle and in the inferior temporal lobe; or the presence of a subcortical U-fiber lesion or a Dawson finger-type lesion). The different image patterns of NMOSD didn't correlate with the clinical prognosis. However, NMOSD patients with more (≧10) brain lesions at onset became wheelchair dependence earlier than those with fewer (<10) brain lesions (log rank test; P < 0.001).
  
  
  CONCLUSIONS
  The diagnostic sensitivity of NMOSD criteria can be increased to 56% by combining the presence of linear ependymal lesions with unmet the Matthews criteria. The prognoses of NMOSD and MS are different. A specific imaging marker, the linear ependymal lesion, was present in some NMOSD patients. The diagnosis of NMOSD can be improved by following the evolution of this imaging feature when anti-AQP4 antibody test results are not available.
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Liao
authors.forename: Kuo-Hsuan
authors.initials: KH
authors.lastname: Chang
authors.forename: Rong-Kuo
authors.initials: RK
authors.lastname: Lyu
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Huang
authors.forename: Hong-Shiu
authors.initials: HS
authors.lastname: Chang
authors.forename: Yih-Ru
authors.initials: YR
authors.lastname: Wu
authors.forename: Chiung-Mei
authors.initials: CM
authors.lastname: Chen
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Chu
authors.forename: Hung-Chou
authors.initials: HC
authors.lastname: Kuo
authors.forename: Long-Sun
authors.initials: LS
authors.lastname: Ro
mesh_terms: D000328:Adult; D051401:Aquaporin 4 / Q000276:immunology; D044466:Asian People; D001323:Autoantibodies / Q000276:immunology; D015415:Biomarkers; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D009471:Neuromyelitis Optica / Q000276:immunology / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D051401:Aquaporin 4; D001323:Autoantibodies; D015415:Biomarkers