title: Spinal cord ring enhancement in patients with neuromyelitis optica.
abstract: OBJECTIVE
  Clinical and pathological significance of gadolinium (Gd)-enhancing pattern on magnetic resonance imaging (MRI), including ring enhancement (RE), is well documented in multiple sclerosis but not in neuromyelitis optica (NMO), especially in the spinal cord. The purpose of this study is to examine the prevalence of spinal cord RE in NMO and to determine the association between clinical characteristics and spinal cord RE.
  
  
  METHODS
  We retrospectively examined Gd-enhanced spinal cord MRI scans, during the acute phase, in patients with anti-aquaporin 4-positive NMO, including NMO spectrum disorder. We then analysed their clinical features and MRI imaging characteristics of spinal cord lesions.
  
  
  RESULTS
  Of the 30 patients with NMO, we enrolled 12 patients with 16 Gd-enhanced spinal cord MRI scans in this study. Five scans revealed RE (31.2%). Male ratio, as well as myelin basic protein (MBP) levels, in the cerebrospinal fluid (CSF) of patients with RE was significantly higher than those of patients without RE (P = 0.018, P = 0.026, respectively).
  
  
  CONCLUSIONS
  Spinal cord RE is common in patients with NMO. Higher MBP levels in the CSF of patients with RE can be associated with a higher degree of myelin damage.
authors: Department of Neurology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan.|Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: H
authors: H
authors: Yokote
authors: Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: Y
authors: Y
authors: Nose
authors: Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: S
authors: S
authors: Ishibashi
authors: Department of Neurology, Kanazawa Medical University, Kanazawa, Tokyo, Japan.
authors: K
authors: K
authors: Tanaka
authors: Department of Multiple sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Tokyo, Japan.
authors: T
authors: T
authors: Takahashi
authors: Department of Multiple sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Tokyo, Japan.
authors: K
authors: K
authors: Fujihara
authors: Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: T
authors: T
authors: Yokota
authors: Department of Neurology and Neurological Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors: H
authors: H
authors: Mizusawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D004676:Myelin Basic Protein / Q000134:cerebrospinal fluid; D009471:Neuromyelitis Optica / Q000134:cerebrospinal fluid / Q000473:pathology*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology*
chemical_list: D004676:Myelin Basic Protein; D005682:Gadolinium
keywords: demyelination; magnetic resonance imaging; multiple sclerosis; myelin basic protein; neuromyelitis optica; ring enhancement; spinal cord