3D-DIR for early differential diagnostic and prognostic evaluation of NMO

Abstract

Abstract. Neuromyelitis optica (NMO) is an acute or subacute lesion of demyelinating disease involving the optic nerve and spinal cord, and imaging techniques and their effects have been the focus of investigations. The aim of the present study was to examine the value of three-dimensional double inverthree-dimensional double inversion recovery (3D-DIR) in the early differential diagnostic and prognostic evaluation of NMO. Forty-eight patients with suspicious NMO were included into the study and underwent a combination of serum NMO-IgG quantitative detection and 3D-DIR examination. Forty cases (83.3%) of the suspicious cases were confirmed with NMO. The average time from onset to definite diagnosis was 3.5±0.6 days. The brain showed high T2W and fluid-attenuated inversion recovery (FLAIR) signals, involving 5.8±1.2 sites on average, distributed in the peripheral lateral ventricle, medulla, cerebral white matter, the third ventricle, peripheral aqueduct of sylvius, pons and dience phalon. The average T2W signal strength was 2.73±0.12. The signal intensity of DIR was significantly higher than that of T2W and FLAIR, and the difference was statistically significant. The optic nerve and chiasma showed a high FLAIR signal, with an average signal intensity of 2.13±0.14. The spinal cord showed swelling, necrosis and cavity lesion, involving the gray and white matter of the central site, transversely, with an average lesion length of 4.7±0.6 centrum. The relative signal intensity of DIR was significantly higher than that of T2W and FLAIR. Following treatment, the signal intensity of the brain, optic nerve, optic chiasma and spinal cord decreased significantly (P<0.05). In conclusion, 3D-DIR has great application value in the early differential diagnostic and prognostic evaluation of NMO. IntroductionNeuromyelitis optica (NMO) is an acute or subacute lesion of demyelinating disease involving optic nerve and spinal cord (1). Previously, NMO was considered a clinical subtype of multiple sclerosis (MS), although the effects of clinical treatment were unsatisfactory (1,2). The development of imaging technology identified NMO and MS as different with regard to the characteristics of lesions.By applying two inversion pulses, three-dimensional double inversion recovery (3D-DIR) sequence significantly improved the signal contrast of different tissues and the imaging effects of gray matter lesions (3). In recent years, 3D-DIR has been gradually applied in the diagnosis of epilepsy, MS and other diseases, and the effects have proven to be satisfactory (4-6).The aim of the present study was to examine the application value of 3D-DIR in the early differential diagnostic and prognostic evaluation of NMO. Materials and methodsPatients. In total, 48 patients diagnosed with suspicious NMO at the Rizhao People's Hospital between October 2013 and October 2015 were included into the present study. All 48 patients were confirmed to be first onset and first treatment according to the clinical symptoms and physical signs. Of the 48 patients, t...

Diagnostik der Neuromyelitis-optica-Spektrum-Erkrankung (NMOSD) und der MOG-Antikörper-assoziierten Erkrankung (MOGAD)

“…B. double inversion recovery, DIR), erleichtert in vielen Fällen den Nachweis langstreckiger Sehnervenveränderungen inkl. einer Beteiligung des Chiasmas [36] (▶ Abb. 3, Abb.…”

“…The use of MR sequences, in which both the CSF and white matter signals are suppressed (e.g. double inversion recovery, DIR) may make it easier to detect lesions or changes in the long segment of the optic nerve, including involvement of the optic chiasm [36] (▶ Fig. 3 and 4).…”