Neurology. 2015 Mar 17;84(11):1165-73. doi: 10.1212/WNL.0000000000001367. Epub 2015 Feb 18.
Kim HJ1, Paul F2, Lana-Peixoto MA2, Tenembaum S2, Asgari N2, Palace J2, Klawiter EC2, Sato DK2, de Seze J2, Wuerfel J2, Banwell BL2, Villoslada P2, Saiz A2, Fujihara K2, Kim SH2; Guthy-Jackson Charitable Foundation NMO International Clinical Consortium & Biorepository.
Abstract
Since its initial reports in the 19th century, neuromyelitis optica (NMO) had been thought to involve only the optic nerves and spinal cord. However, the discovery of highly specific anti-aquaporin-4 antibody diagnostic biomarker for NMO enabled recognition of more diverse clinical spectrum of manifestations. Brain MRI abnormalities in patients seropositive for anti-aquaporin-4 antibody are common and some may be relatively unique by virtue of localization and configuration. Some seropositive patients present with brain involvement during their first attack and/or continue to relapse in the same location without optic nerve and spinal cord involvement. Thus, characteristics of brain abnormalities in such patients have become of increased interest. In this regard, MRI has an increasingly important role in the differential diagnosis of NMO and its spectrum disorder (NMOSD), particularly from multiple sclerosis. Differentiating these conditions is of prime importance because early initiation of effective immunosuppressive therapy is the key to preventing attack-related disability in NMOSD, whereas some disease-modifying drugs for multiple sclerosis may exacerbate the disease. Therefore, identifying the MRI features suggestive of NMOSD has diagnostic and prognostic implications. We herein review the brain, optic nerve, and spinal cord MRI findings of NMOSD.
Article Highlight: Spinal Cord MRI Findings in NMOSD
The inflammatory process of NMOSD in spinal cord MRI is characterized by hyperintensity on T2-weighted sequences and by hypointensity on T1-weighted sequences. These abnormalities in the spinal cord MRI have been reported to be, in general, more frequently present in the cervical and the upper thoracic spinal cord segments than the lower thoracic and lumbar regions with a preferential involvement in the central gray matter.
© 2015 American Academy of Neurology.