Abstract
BACKGROUND AND PURPOSE: Both clinical and imaging criteria must be met to diagnose neuromyelitis optica spectrum disorders and multiple sclerosis. However, neuromyelitis optica spectrum disorders are often misdiagnosed as MS because of an overlap in MR imaging features. The purpose of this study was to confirm imaging differences between neuromyelitis optica spectrum disorders and MS with visually detailed quantitative analyses of large-sample data.
MATERIALS AND METHODS: We retrospectively examined 89 consecutive patients with neuromyelitis optica spectrum disorders (median age, 51 years; range, 16–85 years; females, 77; aquaporin 4 immunoglobulin G–positive, 93%) and 89 with MS (median age, 36 years; range, 18–67 years; females, 68; relapsing-remitting MS, 89%; primary-progressive MS, 7%; secondary-progressive MS, 2%) from 9 institutions across Japan (April 2008 to December 2012). Two neuroradiologists visually evaluated the number, location, and size of all lesions using the Mann-Whitney U test or the Fisher exact test.
RESULTS: We enrolled 79 patients with neuromyelitis optica spectrum disorders and 87 with MS for brain analysis, 57 with neuromyelitis optica spectrum disorders and 55 with MS for spinal cord analysis, and 42 with neuromyelitis optica spectrum disorders and 14 with MS for optic nerve analysis. We identified 911 brain lesions in neuromyelitis optica spectrum disorders, 1659 brain lesions in MS, 86 spinal cord lesions in neuromyelitis optica spectrum disorders, and 102 spinal cord lesions in MS. The frequencies of periventricular white matter and deep white matter lesions were 17% and 68% in neuromyelitis optica spectrum disorders versus 41% and 42% in MS, respectively (location of brain lesions, P < .001). We found a significant difference in the distribution of spinal cord lesions between these 2 diseases (P = .024): More thoracic lesions than cervical lesions were present in neuromyelitis optica spectrum disorders (cervical versus thoracic, 29% versus 71%), whereas they were equally distributed in MS (46% versus 54%). Furthermore, thoracic lesions were significantly longer than cervical lesions in neuromyelitis optica spectrum disorders (P = .001), but not in MS (P = .80).
CONCLUSIONS: Visually detailed quantitative analyses confirmed imaging differences, especially in brain and spinal cord lesions, between neuromyelitis optica spectrum disorders and MS. These observations may have clinical implications.
ABBREVIATIONS:
- AQP4-IgG
- aquaporin 4 immunoglobulin G
- BS
- brain stem
- DGM
- deep gray matter
- DWM
- deep white matter
- IQR
- interquartile range
- NMO
- neuromyelitis optica
- NMOSD
- neuromyelitis optica spectrum disorders
- PVWM
- periventricular white matter
- SCWM
- subcortical white matter
Footnotes
Disclosures: Hiroyuki Tatekawa—RELATED: Grant: Bayer Yakuhin, Ltd (Osaka, Japan).* Shinici Sakamoto—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan).* Yoko Kaichi—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan).* Akira Kunimatsu—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan)*; UNRELATED: Grants/Grants Pending: Daiichi-Sankyo Co Ltd (Tokyo, Japan), Eisai Co Ltd (Tokyo, Japan), Takeda Pharmaceutical Co Ltd (Tokyo, Japan)*; Payment for Lectures Including Service on Speakers Bureaus: Siemens Healthcare Diagnostics K.K. (Tokyo, Japan), Philips Electronics Japan (Tokyo), Toshiba Medical Systems (Tokyo, Japan); Payment for Manuscript Preparation: GE Healthcare Japan (Tokyo, Japan). Kentaro Akazawa—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan)*; UNRELATED: Grants/Grants Pending: Eisai (Tokyo, Japan), Daiichi Pharmaceutical (Tokyo, Japan), Fuji Pharma (Tokyo, Japan)*; Payment for Lectures Including Service on Speakers Bureaus: Daiichi Pharmaceutical (Tokyo, Japan), Eisai (Tokyo, Japan). Toshiteru Miyasaka—UNRELATED: Grants/Grants Pending: Bayer Yakuhin Ltd.* Toshiyuki Okubo—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan).* Kanehiro Hasuo—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan).* Kei Yamada—RELATED: Grant: Bayer Yakuhin Ltd*; UNRELATED: Grants/Grants Pending: Ministry of Health, Welfare and Labor*; Payment for Lectures Including Service on Speakers Bureaus: Eisai, Bayer, Daiichi-Sankyo. Satoshi Doishita—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan).* Taro Shimono—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan).* Yukio Miki—RELATED: Grant: Bayer Yakuhin Ltd (Osaka, Japan).* *Money paid to the institution.
The institutions that had recruited the patients in this study received a grant from Bayer Yakuhin Ltd (Osaka, Japan). The sponsor had no role in the study concept, study design, data analysis, and interpretation, or reporting of results.
Paper previously presented at: Annual Meeting of the Radiological Society of North America, November 26–December 1, 2017; Chicago, Illinois.
- © 2018 by American Journal of Neuroradiology
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