Differentiation of Neuromyelitis Optica from Multiple Sclerosis on Spinal Magnetic Resonance Imaging

Abstract

In order to examine the accuracy of magnetic resonance imaging (MRI)-based diagnosis of neuromyelitis optica (NMO) versus multiple sclerosis (MS), we performed a retrospective, rater-blinded review of 29 cases of NMO and 30 cases of MS using the criteria of long (more than three vertebral levels), continuous lesions with a central cord location for NMO and more peripheral and patchy lesions for MS. Using these criteria, two raters were able to distinguish the two conditions with a good degree of confidence, particularly when the imaging was performed at the time of an acute cord attack. The sensitivity and specificity for diagnosis of NMO were 86.2% and 93.3%, respectively, for Rater A and 96.4% and 78.6%, respectively, for Rater B, with a kappa value of 0.72. Thus there are significant differences in lesion characteristics that allow the distinction on spinal cord imaging between MS and NMO with a moderately high degree of confidence. The location of the lesion as evident on MRI of the spine can be regarded as a distinguishing diagnostic feature between MS and NMO.

Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico

“…Paraclinical imaging of brain-associated MRI lesions is widely employed for NMOSD supportive diagnosis but most importantly as a tool for differentiating NMOSD from MS.[ 146 ] Early asymptomatic NMOSD onset usually does not display any MRI scan lesions and almost always will be performed before the specific NMO-IgG biomarker serology. [ 67 ] However, if the lesions were present, imaging scan will reveal subcortical lesions without central veins.…”

“…[ 198 ] OCT employs low-coherent light to produce backscattered and reflected cross-sectional high-resolution 3D images of retinal structures that reveal NMOSD-specific intraretinal pathologies, but most importantly, OCT can provide differential diagnosis between MS and NMOSD. [ 165 198 ] In NMOSD patients, acute single ON attack causes more damage to pRNFL and GCIPL layers that can be detected via OCT.[ 146 ] Currently, OCT is widely used to measure NMOSD disease progression course, as well as outcome response to NMOSD neuroprotective therapies. [ 269 ]…”

Detection of Antibodies against Human and Plant Aquaporins in Patients with Multiple Sclerosis

“…Although MS and NMO are now recognized as two distinct illnesses [ 18 , 19 ] for years similar clinical manifestations led to one being misdiagnosed as the other or led some to think that NMO was a severe form of MS. The introduction of the NMO antibody permitted clearer differentiation between the two disorders and increased the accuracy of diagnosis [ 19 ].…”

Detection of antibodies against human and plant aquaporins in patients with multiple sclerosis

“…The introduction of the NMO antibody permitted clearer differentiation between the two disorders and increased the accuracy of diagnosis [19].…”