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Comparison between the cranial magnetic resonance imaging features of neuromyelitis optica spectrum disorder versus multiple sclerosis in Taiwanese patients.

Liao MF, Chang KH, Lyu RK, Huang CC, Chang HS, Wu YR, Chen CM, Chu CC, Kuo HC, Ro LS - BMC Neurol (2014)

Bottom Line: The different image patterns of NMOSD didn't correlate with the clinical prognosis.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.

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

Wheelchair dependence occurred earlier in NMOSD patients than MS patients (log rank test;P = 0.036). NMOSD: neuromyelitis optica spectrum disorder; MS: multiple sclerosis.
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Fig3: Wheelchair dependence occurred earlier in NMOSD patients than MS patients (log rank test;P = 0.036). NMOSD: neuromyelitis optica spectrum disorder; MS: multiple sclerosis.

Mentions: Of the 31 patients with NMO fulfilling the Wingerchuk 2006 criteria, 25 (81%) had brain lesions and were diagnosed as having NMOSD. All above patients had long-segment cervical or thoracic myelitis (≥3 segments) confirmed by MRI studies during follow-up periods. Of the 29 patients with MS meeting the Poser criteria, all fitted the clinical presentations of MS and had negative anti-AQP4 antibody tests. The age of onset in NMOSD patients (37.8 ± 13.6 years old) was similar to that in MS patients (33.7 ± 9.2 years old, Table 1). The follow-up period was longer in NMOSD patients (129.0 ± 69.5 months) than in MS patients (77.6 ± 64.2 months, P = 0.007). Sensory disturbances were the most common symptoms occurring during the follow-up period in both NMOSD patients (100%) and MS (79%) patients. Symptoms of weakness (100% vs. 69%, P = 0.002), sensory disturbance (100% vs. 79%, P = 0.025), blurred vision (100% vs. 66%, P = 0.001), and urine/stool retention (48% vs. 10%, P = 0.003) were more frequently seen in NMOSD patients. On the other hand, diplopia (34% vs. 8%, P = 0.025) and dysphagia/dysarthria (24% vs. 0%, P = 0.012) were more frequently seen in MS patients. Common endocrinopathies (diabetes mellitus, and thyroid dysfunction), polyuria (8% vs. 0%, P = 0.210), and hiccup (8% vs. 0%, P = 0.210) occurred with similar frequency in both groups. Five NMOSD patients but no MS patient had respiratory failure (20% vs. 0%, P = 0.017) and two of these five died from pneumonia and sepsis. Eleven of 25 (44%) NMOSD patients and 1 of 29 (3.4%) MS patients became wheelchair dependent during the follow-up periods (log rank test; P = 0.036) (Figure 3).Table 1


Comparison between the cranial magnetic resonance imaging features of neuromyelitis optica spectrum disorder versus multiple sclerosis in Taiwanese patients.

Liao MF, Chang KH, Lyu RK, Huang CC, Chang HS, Wu YR, Chen CM, Chu CC, Kuo HC, Ro LS - BMC Neurol (2014)

Wheelchair dependence occurred earlier in NMOSD patients than MS patients (log rank test;P = 0.036). NMOSD: neuromyelitis optica spectrum disorder; MS: multiple sclerosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4264553&req=5

Fig3: Wheelchair dependence occurred earlier in NMOSD patients than MS patients (log rank test;P = 0.036). NMOSD: neuromyelitis optica spectrum disorder; MS: multiple sclerosis.
Mentions: Of the 31 patients with NMO fulfilling the Wingerchuk 2006 criteria, 25 (81%) had brain lesions and were diagnosed as having NMOSD. All above patients had long-segment cervical or thoracic myelitis (≥3 segments) confirmed by MRI studies during follow-up periods. Of the 29 patients with MS meeting the Poser criteria, all fitted the clinical presentations of MS and had negative anti-AQP4 antibody tests. The age of onset in NMOSD patients (37.8 ± 13.6 years old) was similar to that in MS patients (33.7 ± 9.2 years old, Table 1). The follow-up period was longer in NMOSD patients (129.0 ± 69.5 months) than in MS patients (77.6 ± 64.2 months, P = 0.007). Sensory disturbances were the most common symptoms occurring during the follow-up period in both NMOSD patients (100%) and MS (79%) patients. Symptoms of weakness (100% vs. 69%, P = 0.002), sensory disturbance (100% vs. 79%, P = 0.025), blurred vision (100% vs. 66%, P = 0.001), and urine/stool retention (48% vs. 10%, P = 0.003) were more frequently seen in NMOSD patients. On the other hand, diplopia (34% vs. 8%, P = 0.025) and dysphagia/dysarthria (24% vs. 0%, P = 0.012) were more frequently seen in MS patients. Common endocrinopathies (diabetes mellitus, and thyroid dysfunction), polyuria (8% vs. 0%, P = 0.210), and hiccup (8% vs. 0%, P = 0.210) occurred with similar frequency in both groups. Five NMOSD patients but no MS patient had respiratory failure (20% vs. 0%, P = 0.017) and two of these five died from pneumonia and sepsis. Eleven of 25 (44%) NMOSD patients and 1 of 29 (3.4%) MS patients became wheelchair dependent during the follow-up periods (log rank test; P = 0.036) (Figure 3).Table 1

Bottom Line: The different image patterns of NMOSD didn't correlate with the clinical prognosis.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.

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus