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Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?

  • Diagnostic Neuroradiology
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Abstract

Introduction

Neuromyelitis optica (NMO) is a severe demyelinating disease that preferentially involves spinal cord and optic nerve. It is part of a spectrum of neurological conditions associated with antibodies to aquaporin-4 (AQP4). This study investigates the role of MRI where novel, more sensitive AQP4 antibody immunoassay techniques are being used.

Methods

Retrospective review of neuroimaging in 69 patients (25 antibody positive, 44 antibody negative), investigated in the context of suspected NMO or NMO spectrum disorder, was performed independently by two consultant neuroradiologists.

Results

Longitudinally extensive, central spinal cord lesions were more frequent in AQP4 positive patients (95.2% vs 35.5%, p < 0.0001; 85.7% vs 45.2%, p = 0.015). Multiple sclerosis diagnostic criteria were less frequently fulfilled on brain MRI in antibody positive patients (5.6% vs 33.3%, p = 0.035). Juxtacortical and corpus callosal lesions were also less common in this group (16.7% vs 46.7%, p = 0.063; 5.6% vs 46.7%, p = 0.0034). Hypothalamic and periependymal disease related to the aqueduct was not seen in antibody negative patients. T1 hypointensity was more common in cord lesions of antibody positive patients (75.0% vs 35.3%, p = 0.037). However, this characteristic did not discriminate antibody positive and negative longitudinally extensive cord lesions (73.3% vs 62.5%, p = 0.66).

Conclusion

The NMO spectrum of diseases are among an increasing number of neurological conditions defined by serological tests. However, despite improved immunoassay techniques, MRI of the brain and spinal cord continues to be among the first-line investigations in these patients, providing valuable diagnostic information that will help guide patient management.

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Acknowledgements

We would like to thank the consultant neurologists of the Nuffield Department of Neurosciences for referring patients, and Professor A Vincent and Dr P Waters for their research regarding AQP4 antibody detection.

Conflict of interest

J Palace has served on scientific advisory committees for Bayer Schering, Merck Serono, Teva and Biogen Idec, Novartis UK.

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Authors and Affiliations

  1. Department of Neuroradiology, John Radcliffe Hospital, West Wing, Level 1, OX3 9DU, Oxford, UK

    Jonathan James Downer, Ranjana Carter, Wilhelm Küker & Gerardine Quaghebeur

  2. Department of Clinical Neurology, Oxford University, Oxford, UK

    Maria Isabel Leite & Jacqueline Palace

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  1. Jonathan James Downer
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  2. Maria Isabel Leite
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  3. Ranjana Carter
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Correspondence to Gerardine Quaghebeur.

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Downer, J.J., Leite, M.I., Carter, R. et al. Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?. Neuroradiology 54, 279–285 (2012). https://doi.org/10.1007/s00234-011-0875-x

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  • DOI: https://doi.org/10.1007/s00234-011-0875-x

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