Brain magnetic resonance imaging findings in acute relapses of neuromyelitis optica spectrum disorders

Cabrera-Gómez, JA; Saiz-Hinarejos, A.; Graus, Francesc; González‐Quevedo, Alina; Rodríguez‐Rojas, Rafael; Quevedo-Sotolongo, L; Real-González, Y; Grass-Fernández, D; Cristofol-Corominas, M; Rodríguez-Cordero, ML; Robinson-Agramonte, MA; Infante-Velázquez, E.; Cabrera-Núñez, A Y; Ugarte-Sánchez, C.; Jordán-González, J; Nuez, JE González de la; García-Lahera, J.; Tellez, R.; Báez-Martín, Margarita Minou; Romero-García, K

doi:10.1177/1352458507082617

Cited by 29 publications

(17 citation statements)

References 5 publications

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“…20,21 Also consistent with previous case studies is our observation that the most common location for an NMOSD lesion is deep white matter. 19,22,23 We also show that medullary lesions are more common in NMOSD than RRMS. These lesions may be contiguous with a high cervical spinal cord lesion.…”

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confidence: 58%

Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution

et al. 2013

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Objective: Neuromyelitis optica and its spectrum disorder (NMOSD) can present similarly to relapsingremitting multiple sclerosis (RRMS). Using a quantitative lesion mapping approach, this research aimed to identify differences in MRI brain lesion distribution between aquaporin-4 antibody-positive NMOSD and RRMS, and to test their diagnostic potential.Methods: Clinical brain MRI sequences for 44 patients with aquaporin-4 antibody-positive NMOSD and 50 patients with RRMS were examined for the distribution and morphology of brain lesions. T2 lesion maps were created for each subject allowing the quantitative comparison of the 2 conditions with lesion probability and voxel-wise analysis.Results: Sixty-three percent of patients with NMOSD had brain lesions and of these 27% were diagnostic of multiple sclerosis. Patients with RRMS were significantly more likely to have lesions adjacent to the body of the lateral ventricle than patients with NMOSD. Direct comparison of the probability distributions and the morphologic attributes of the lesions in each group identified criteria 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's finger-type lesion," which could distinguish patients with multiple sclerosis from those with NMOSD with 92% sensitivity, 96% specificity, 98% positive predictive value, and 86% negative predictive value. Neuromyelitis optica (NMO) is an inflammatory demyelinating condition of the CNS with a predilection for the optic nerves and spinal cord. NMO spectrum disorder (NMOSD) is a term used to encompass NMO (with both optic neuritis and myelitis) 1 and limited phenotypes such as recurrent optic neuritis or myelitis. It is an autoimmune disorder, mediated in most cases by antibodies to the aquaporin-4 (AQP4) water channel, 2,3 and for the majority of patients serum AQP4 antibodies (AQP4-abs) can be detected with an immunoassay. 4 Making a definitive diagnosis of antibodynegative NMOSD can be challenging because the more prevalent relapsing-remitting multiple sclerosis (RRMS) can present similarly (e.g., with attacks of optic neuritis and myelitis). 1,5,6 It is vitally important to distinguish these 2 conditions: patients with NMOSD require long-term immunosuppression to prevent devastating relapses, and disease-modifying treatments for RRMS such as b-interferon can worsen NMOSD. Conclusion:7,8 Hence, we need other markers to help promptly identify those who should be antibody tested, and to diagnose seronegative disease.MRI is the best noninvasive tool we have for visualizing the pathology of neuroinflammatory diseases in vivo, and has proven particularly useful in identifying patients with longitudinally extensive transverse myelitis (LETM), which is highly suggestive of NMOSD.

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confidence: 58%

Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution

et al. 2013

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“…Details of these cases have been published [42]. Only the one patient with severe monophasic ON, case 40, has remained stable, but she has not been available to test for the antibody.…”

Section: Initial Events and Coursementioning

confidence: 99%

An epidemiological study of neuromyelitis optica in Cuba

Cabrera-Gómez¹,

et al. 2009

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“…] It is not known why brain lesions in NMO are often asymptomatic, whereas spinal cord and optic nerve lesions are rarely, if ever, asymptomatic. Furthermore, NMO brain lesions that are hyperintense on T2-weighted imaging are typically not hypointense on T1-weighted imaging and often resolve over time [ 31 ]. It is possible that such lesions could correspond to a more transient pathologic process, such as edema, rather than demyelination.…”

Section: The Anti-aqp4 Antibody and Pathogenesismentioning

confidence: 99%

Neuromyelitis optica: Diagnosis, pathogenesis, and treatment

Cree

2008

Curr Neurol Neurosci Rep

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Although the co-occurrence of myelitis and optic neuritis that characterizes neuromyelitis optica (NMO) was recognized over a century ago, distinguishing NMO from multiple sclerosis relied solely on clinical criteria until recently. The identification of a biomarker that has high specificity for NMO is clinically useful for distinguishing NMO from multiple sclerosis and identifying patients at high risk for recurrent myelitis and optic neuritis. That fact that the biomarker is an autoantibody that recognizes aquaporin 4 (AQP4), a water channel expressed on astrocyte podocytes, has substantially contributed to the hypothesis that NMO is a humorally mediated autoimmune disease. This review discusses the discovery of the NMO-IgG biomarker, the identification of AQP4 as its target, the clinical applications of these advances, the pathologic implications for the anti-AQP4 antibody, and advances in NMO treatment.

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Brain magnetic resonance imaging findings in acute relapses of neuromyelitis optica spectrum disorders

Cited by 29 publications

References 5 publications

Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution

Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution

An epidemiological study of neuromyelitis optica in Cuba

Neuromyelitis optica: Diagnosis, pathogenesis, and treatment

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