title: Differentiating neuromyelitis optica from other causes of longitudinally extensive transverse myelitis on spinal magnetic resonance imaging.
abstract: BACKGROUND
  Although spinal magnetic resonance imaging (MRI) findings of neuromyelitis optica (NMO) have been described, there is limited data available that help differentiate NMO from other causes of longitudinally extensive transverse myelitis (LETM).
  
  
  OBJECTIVE
  To investigate the spinal MRI findings of LETM that help differentiate NMO at the acute stage from multiple sclerosis (MS) and other causes of LETM.
  
  
  METHODS
  We enrolled 94 patients with LETM into our study. Bright spotty lesions (BSL), the lesion distribution and location were evaluated on axial T2-weighted images. Brainstem extension, cord expansion, T1 darkness and lesion enhancement were noted. We also reviewed the brain MRI of the patients during LETM.
  
  
  RESULTS
  Patients with NMO had a greater amount of BSL and T1 dark lesions (p < 0.001 and 0.003, respectively). The lesions in NMO patients were more likely to involve greater than one-half of the spinal cord's cross-sectional area; to enhance and be centrally-located, or both centrally- and peripherally-located in the cord. Of the 62 available brain MRIs, 14 of the 27 whom were NMO patients had findings that may be specific to NMO.
  
  
  CONCLUSIONS
  Certain spinal cord MRI features are more commonly seen in NMO patients and so obtaining brain MRI during LETM may support diagnosis.
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Pekcevik
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Mitchell
authors.affiliation: Johns Hopkins Transverse Myelitis and Multiple Sclerosis Centers, Baltimore, MD, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Mealy
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Gunes
authors.initials: G
authors.lastname: Orman
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA/Department of Radiology, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: In H
authors.initials: IH
authors.lastname: Lee
authors.affiliation: Division of Neuroimmunology and Neuroinfectious Diseases, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Newsome
authors.affiliation: Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA.
authors.forename: Carol B
authors.initials: CB
authors.lastname: Thompson
authors.affiliation: Division of Neuroimmunology and Neuroinfectious Diseases, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pardo
authors.affiliation: Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Calabresi
authors.affiliation: Department of Neurology, Johns Hopkins Hospital, Neuromyelitis Optica Clinic Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA iizbuda1@jhmi.edu.
authors.forename: Izlem
authors.initials: I
authors.lastname: Izbudak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000000981:diagnostic imaging*; D009188:Myelitis, Transverse / Q000209:etiology*; D009471:Neuromyelitis Optica / Q000150:complications* / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology; D055815:Young Adult
keywords: Brain; diagnostic imaging; lesions; magnetic resonance imaging; neuroimaging; neuromyelitis optica; spinal cord; transverse myelitis