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

Abstract

BackgroundNeuromyelitis 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).MethodsThe 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.ResultsTwenty-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).ConclusionsThe 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.

Concurrent Dawson’s Fingers and Area Postrema Lesion in a Mixed Neuroimmune Disorder

“…The coexistence of these MRI signal characteristics is in line with earlier reports that such patterns may not be as disease-specific as currently believed 8 . In a study of Taiwanese patients with MS or NMOSD, 8 imaging patterns considered to be specific 8 failed to distinguish the two conditions: 11 (44%) of 25 NMOSD patients and 16 (55%) of 29 MS patients showed findings consistent with Dawson’s fingers 8 . In striking contrast, Matthews et al reported Dawson’s fingers in none of the 26 patients with NMOSD versus 41 (82%) of 50 patients with MS 7 .…”

“…In contrast, corpus callosal lesions perpendicular to the lateral ventricle (i.e. Dawson's fingers) are highly suggestive radiographic findings of MS 7,8 and maybe considered a red flag for diagnosis of NMOSD (except for longitudinal callosal lesions). 2,7 The coexistence of these MRI signal characteristics is in line with earlier reports that such patterns may not be as diseasespecific as currently believed.…”

“…2,7 The coexistence of these MRI signal characteristics is in line with earlier reports that such patterns may not be as diseasespecific as currently believed. 8 In a study of Taiwanese patients with MS or NMOSD, 8 imaging patterns considered to be specific 8 failed to distinguish the two conditions: 11 (44%) of 25 NMOSD patients and 16 (55%) of 29 MS patients showed findings consistent with Dawson's fingers. 8 In striking contrast, Matthews et al reported Dawson's fingers in none of the 26 patients with NMOSD versus 41 (82%) of 50 patients with MS. 7 Such discrepancies in observations may suggest that these imaging patterns are indicative of ethnic variations or simply the diversity of idiosyncratic response patterns; however, we found no reports of unique imaging for MS or NMOSD in populations of African descent.…”

Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan

“…5,31 These European studies suggested that the presence of these lesions could distinguish MS from NMOSD with high sensitivity and specificity, but this may not apply to Asian patients with NMOSD. 32,33 Genetic or environmental factors depending on different areas such as Asia and Europe were reported to affect imaging differences in patients with MS in different areas. 34 The imaging appearances of NMOSD may also differ between Asian and European patients.…”

NMOSD with an unusual cerebral radiologic manifestation

“…Some types of involvements such as brainstem and diencephalon have been noticed in new criteria for NMOSD (Wingerchuk et al, 2015). The frequencies of brain lesions during the course of disease in NMOSD patients are different in various studies and differ from 30% to 81% (Liao et al, 2014). NMSOD manifestations may also be in the form of cerebral involvement without optic neuritis and/or myelitis (Kim et al, 2012).…”