title: Longitudinally extensive optic neuritis as an MRI biomarker distinguishes neuromyelitis optica from multiple sclerosis.
abstract: OBJECTIVE
  To differentiate MRI characteristics of optic neuritis associated with neuromyelitis optica (NMO) and relapsing remitting multiple sclerosis (RRMS).
  
  
  BACKGROUND
  Optic neuritis is a common presenting feature of both neuromyelitis optica and multiple sclerosis. Distinguishing between NMO and RRMS is important in guiding treatment, but biomarkers of NMO and MS can be absent early in the disease process. We looked for differences in MRI characteristics of optic neuritis associated with NMO and MS that provide an early clue in the diagnostic workup.
  
  
  METHODS
  We conducted a retrospective analysis of 26 NMO and 26 RRMS patients presenting to the Johns Hopkins Hospital with MRI-confirmed acute optic neuritis. MRIs were assessed to identify the location and longitudinal extent of each contrast enhancing lesion. For the purposes of this study, the optic nerve was divided into intraorbital, canalicular, pre-chiasmal, chiasmal, and optic tract.
  
  
  RESULTS
  There are distinct differences in MRI characteristics between NMO- and RRMS-associated optic neuritis. The majority of NMO lesions were longitudinally extensive measuring at least 17.6mm in length and involving at least three optic nerve segments. At a cutoff of 17.6mm lesion length, the specificity for NMO is 76.9% with a sensitivity of 80.8% and positive likelihood ratio of 3.50. Conversely, MS lesions were more commonly focal in one optic nerve segment localized anteriorly.
  
  
  CONCLUSIONS
  Optic neuritis in NMO has a distinct pattern on MRI as compared with RRMS and can help differentiate these two neuroinflammatory diseases at presentation.
authors.affiliation: Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Mealy
authors.affiliation: Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Whetstone
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Gunes
authors.initials: G
authors.lastname: Orman
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Izlem
authors.initials: I
authors.lastname: Izbudak
authors.affiliation: Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Calabresi
authors.affiliation: Department of Neurology, Johns Hopkins University, Baltimore, MD, USA. Electronic address: mlevy@jhmi.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis*; D009902:Optic Neuritis / Q000175:diagnosis*; D012372:ROC Curve; D018709:Statistics, Nonparametric; D055815:Young Adult
keywords: Aquaporin-4; Bilateral optic neuritis; Longitudinally extensive optic neuritis; MRI; Neuromyelitis optica