MRI differential diagnosis of suspected multiple sclerosis

Chen, J.J.; Carletti, Francesco; Young, Victoria; McKean, David; Quaghebeur, Gerardine

doi:10.1016/j.crad.2016.05.010

Cited by 36 publications

(22 citation statements)

References 46 publications

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“…There is a previous report of iron deposition in the deep gray matter of NMOSD patients, although the amount of iron was less than in MS patients. 42 The pathomechanism of paramagnetic rims in NMOSD remains to be clarified, including the contribution of iron to lesion development. Further studies are needed to confirm the histopathologic findings of NMOSD lesions with paramagnetic rims.…”

Section: Discussionmentioning

confidence: 99%

Paramagnetic Rims in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Quantitative Susceptibility Mapping Study with 3-T MRI

et al. 2020

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Background and Purpose Iron retained by activated microglia and macrophages in multiple sclerosis (MS) lesions may serve as a marker of innate immune system activation. Among several magnetic resonance imaging (MRI) methods, there has been recent interest in using quantitative susceptibility mapping (QSM) as a potential tool for assessing iron levels in the human brain. This study examined QSM findings in MS and neuromyelitis optica spectrum disorder (NMOSD) lesions obtained with 3-T MRI to assess imaging characteristics related to paramagnetic rims around brain lesions in MS and NMOSD. Methods This study included 32 MS and 21 seropositive NMOSD patients. MRI images were obtained using two 3-T MRI devices (Ingenia, Philips Healthcare; and Magnetom Verio, Siemens Healthineers) during routine diagnosis and treatment procedures. Multi and single echo gradient echo magnitude and phase images were obtained for QSM reconstruction. QSM images were used to characterize the detected lesions, and the findings were compared between MS and NMOSD. Results Totals of 71 and 35 MRI scans were performed during the study period in MS and NMOSD patients, respectively. In QSM images, paramagnetic rims were found in 26 (81.2%) MS patients and 1 (4.8%) NMOSD patient. Eight of the 22 MS patients and only 1 of the 10 NMOSD patients who underwent follow-up MRI showed new paramagnetic rims. The paramagnetic rim lesions appeared after enhancement or in new T2-weighted lesions without enhancement. Conclusions Paramagnetic rims might be a characteristic MRI finding for MS, and therefore they have potential as an imaging marker for differentially diagnosing MS from NMOSD using 3-T MRI.

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Section: Discussionmentioning

confidence: 99%

Paramagnetic Rims in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Quantitative Susceptibility Mapping Study with 3-T MRI

et al. 2020

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“…These lesions most likely represent an ischemic microangiopathy not related to immune causes. In contrast to MS, the white matter lesions of this non-specific ischemic microangiopathy (1) do not demonstrate enhancement, (2) tend to spare the corpus callosum subcortical U-fibers and spinal cord, (3) commonly affect the basal ganglia with lacune formation, and (4) affect the central rather than peripheral portions of the brainstem [54]. …”

Section: Diagnosismentioning

confidence: 99%

Neurological Complications of Sjögren’s Syndrome: Diagnosis and Management

McCoy

Baer

2017

Curr Treat Options in Rheum

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Opinion statement Purpose of review Neurologic disease is a common extraglandular manifestation of Sjögren’s syndrome (SS), the study of which has been hampered both by the lack of uniform definitions for specific neurologic complications and by the imprecision of the tools used to diagnose SS. There is a great need to develop consensus criteria for classifying these varied neurologic manifestations, as has been done in systemic lupus erythematosus (SLE) “Arthritis and rheumatism 42:599-608, 1999”. SS patients with certain forms of neurologic involvement, such as small fiber neuropathy and sensory ataxic ganglionopathy, frequently lack anti-SSA and anti-SSB antibodies and other serologic abnormalities. In these patients, neurologic disease is often their presenting manifestation, triggering a search for underlying SS. Given the frequent seronegativity of such patients, their diagnosis of SS rests heavily on the interpretation of a labial gland biopsy. However, these biopsies are prone to misinterpretation “Vivino etal. J Rheumatol 29:938-44, 2002”, and “positive” ones are found in up to 15% of healthy volunteers “Radfar et al. Arthrit Rheumatu 47:520-4, 2002”. Better diagnostic tools are needed to determine if the frequent seronegative status of these SS patients may be related to a unique disease pathogenesis. Recent findings Recent advances in diagnostic techniques have served to define a likely pathogenetic basis for certain neurologic manifestations of SS. The advent of punch skin biopsies to analyze intraepidermal nerve fiber density and morphology has helped define pure sensory small fiber neuropathy as common in SS and the basis for both length- and non-length-dependent patterns of neuropathic pain. New protocols for magnetic resonance imaging (MRI) have enabled the recognition of dorsal root ganglionitis, a finding originally detected in pathologic studies. The advent of the anti-aquaporin-4 (AQP4) antibody test in 2004 has Led to the appreciation that demyelinating disease in SS is often related to the presence of neuromyelitis optica spectrum disorder. The anti-AQP4 antibody is considered to be directly pathogenic in the brain, targeting the primary water channel proteins in the brain, expressed prominently on astrocytic foot processes. Summary There are no clinical trials evaluating the efficacy of systemic immune suppressive therapy for peripheral or central nervous system involvement. With the recent increase in clinical trials of biologic agents for SS, which utilize systemic disease manifestations as standardized outcome measures, there is an urgency to deveLop appropriate definitions of neuroLogic compLications of SS and cLear parameters for clinical improvement.

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“…According to many studies, computed tomography (CT) scanning has poor sensitivity in diagnosis, assessment, and categorization of MS lesions, hence its evaluation is merely limited to magnetic resonance imaging (MRI) (6)(7)(8). MRI was first applied in the late 1980s to detect MS in the upper cervical cord (9).…”

Section: Introductionmentioning

confidence: 99%

Comparison Between T2, STIR and PSIR Sequences, for Detection of Cervical Cord MS Plaques

et al. 2019

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Background: Multiple sclerosis (MS) is a demyelinating disease, involving almost 2.5 million people around the world. There are different MR pulse sequences, which are used to detect MS plaques. Objectives: This study aimed to compare, T2 weighted, short-tau inversion recovery (STIR) and phase-sensitive inversion recovery (PSIR) pulse sequences, for detecting cervical spinal cord lesions in MS patients. Patients and Methods: Sixty patients with definite MS diagnoses, participated in this study from June to December 2016. 1.5 T Siemens (Avanto, Erlangen, Germany) MR scanner and three pulse sequences (T2 weighted, STIR and PSIR sequences) were used for cervical cord MR imaging. To assess the effectiveness of these pulse sequences, the lesion to cord ratio (LCR) and lesion to noise ratio (LNR) were calculated. Results: The LCR and LNR of the T2 and PSIR were the same (LCR of 0.04,-0.03 and LNR of 2.74,-2.09 respectively), just the intensities were reverse. STIR had a significantly different LCR and LNR [0.23 (P < 0.001) and 22.7(P < 0.001) respectively], hence it was better in diagnosing cervical cord MS plaques. Conclusion: According to the results, using 1.5 T MRI machine, it implies that the STIR pulse sequence was the best pulse sequence in comparison to T2 and PSIR in detecting cervical cord MS plaques.

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MRI differential diagnosis of suspected multiple sclerosis

Cited by 36 publications

References 46 publications

Paramagnetic Rims in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Quantitative Susceptibility Mapping Study with 3-T MRI

Paramagnetic Rims in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Quantitative Susceptibility Mapping Study with 3-T MRI

Neurological Complications of Sjögren’s Syndrome: Diagnosis and Management

Comparison Between T2, STIR and PSIR Sequences, for Detection of Cervical Cord MS Plaques

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