The current role of MRI in differentiating multiple sclerosis from its imaging mimics

Geraldes, Ruth; Ciccarelli, Olga; Barkhof, Frederik; Stefano, Nicola De; Enzinger, Christian; Filippi, Massimo; Hofer, Monika; Paul, Friedemann; Preziosa, Paolo; Rovira, Àlex; DeLuca, Gabriele C.; Kappos, Ludwig; Yousry, Tarek; Fazekas, Franz; Frederiksen, Jette Lautrup; Gasperini, Claudio; Sastre‐Garriga, Jaume; Evangelou, Nikos; Palace, Jacqueline

doi:10.1038/nrneurol.2018.14

Cited by 180 publications

(140 citation statements)

References 174 publications

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“…Secondly, brain MRI data were not available in this study. NMOSD patients frequently have non‐specific punctate or small patchy lesions in the subcortical or deep white matter; however, symptomatic brain lesions are less frequent compared with MS . Therefore, it is believed that a lack of brain MRI data does not severely reduce the significance of our study results, at least for NMOSD.…”

Section: Discussionmentioning

confidence: 88%

Spinal cord involvement by atrophy and associations with disability are different between multiple sclerosis and neuromyelitis optica spectrum disorder

Nakamura¹,

Liu²,

Fukumoto³

et al. 2019

Euro J of Neurology

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Background and purpose The cervical and thoracic cross‐sectional spinal cord area (CS‐SCA) in multiple sclerosis (MS) correlates with disability, whilst such a correlation remains to be established in neuromyelitis optica spectrum disorder (NMOSD). Our aim was to clarify differences between MS and NMOSD in spinal cord segments where CS‐SCA is associated with disability. Methods The CS‐SCA at C2/C3, C3/C4, T8/T9 and T9/T10 vertebral disc levels was measured in 140 MS patients (111 with relapsing–remitting MS and 29 with progressive MS) and 42 NMOSD patients with anti‐aquaporin‐4 immunoglobulin G. Disability was evaluated by Expanded Disability Status Scale (EDSS) scores. Multivariate associations between CS‐SCA and disability were assessed by stepwise forward multiple linear regression. Results Thoracic CS‐SCA was significantly smaller in NMOSD patients than in MS patients even after adjusting for age, sex and disease duration (P = 0.002 at T8/T9), whilst there was no difference in cervical CS‐SCA between the two diseases. Cervical and thoracic CS‐SCA had a negative correlation with EDSS scores in MS patients (P < 0.0001 at C3/C4 and P = 0.0002 at T8/T9) whereas only thoracic CS‐SCA correlated with EDSS scores in NMOSD patients (P = 0.0006 at T8/T9). By multiple regression analyses, predictive factors for disability in MS were smaller cervical CS‐SCA, progressive course, older age and a higher number of relapses, whilst those in NMOSD were smaller thoracic CS‐SCA and older age. Conclusions Thoracic CS‐SCA is a useful predictive marker for disability in patients with NMOSD whilst cervical CS‐SCA is associated with disability in patients with MS.

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Section: Discussionmentioning

confidence: 88%

Spinal cord involvement by atrophy and associations with disability are different between multiple sclerosis and neuromyelitis optica spectrum disorder

Nakamura¹,

Liu²,

Fukumoto³

et al. 2019

Euro J of Neurology

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“…MS is a progressive neurodegenerative disease currently assessed using a combination of clinical criteria and findings on MRI (Lublin, ; Geraldes et al, ). MRI evaluation in particular relies on visualization of dissemination in time and space of demyelinating lesions, the presence of which is considered a de facto marker of disease presence rather than a predictor biomarker of disease course (Cahalane et al, ).…”

Section: Discussionmentioning

confidence: 99%

Optic Chiasm Morphometric Changes in Multiple Sclerosis: Feasibility of a Simplified Brain Magnetic Resonance Imaging Measure of White Matter Atrophy

2019

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Sophisticated volume measurements of brain structures on magnetic resonance imaging (MRI) may improve specificity in determining long-term progression of multiple sclerosis (MS), but these techniques are laborious. The optic chiasm (OC) is a white matter (WM) structure clearly visible on a routine MRI and is related to the optic nerves (ONs), which are known to atrophy in MS. We hypothesized that OC morphometric measurements would show OC atrophy in MS compared to normal patients. If so, this could help establish a novel simplified brain MRI measure of WM atrophy in MS patients. We retrospectively evaluated standard brain MRIs of 97 patients with known MS and 98 normal individuals. We electronically measured eight OC morphometrics on axial T2WIs and midsagittal T1WIs: OC width and anteroposterior (AP) diameter, diameters of each ON and optic tract (OT), and angles between the ONs or OTs. Mean OC width, AP diameter, and height in MS patients were 11.83 AE 1.25 mm (95% CI 11.58-12.09), 2.99 AE 0.65 mm (95% CI 2.85-3.12), and 2.09 AE 0.37 mm (95% CI 2-2.19), respectively. In normal individuals, they were 12.1 AE 1.4 mm (95% CI 11.78-12.34), 3.43 AE 0.63 mm (95% CI 3.3-3.58), and 2.15 AE 0.37 mm (95% CI 2.07-2.23), respectively. There were statistically significant differences between MS patients and controls for AP diameter (P = 0.000), but not for width (P = 0.204) or height (P = 0.183). The ONs were significantly smaller in MS (P < 0.0017), but not the OTs. Thus, the OC is significantly atrophied in an unstratified cohort of MS patients. Future studies may establish an MRI OC morphometric index to evaluate demyelinating disease in the brain.

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“…However, MRI lesions similar to those found in MS can occur in other disorders, and MRI criteria should not be applied in patients with atypical clinical presentations 6. If there is doubt regarding the nature of symptoms or signs, patients require further evaluation 7.…”

Section: Commentarymentioning

confidence: 99%

New MS diagnostic criteria in practice

Angelis¹,

Brownlee

Chard

et al. 2018

Pract Neurol

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The current role of MRI in differentiating multiple sclerosis from its imaging mimics

Cited by 180 publications

References 174 publications

Spinal cord involvement by atrophy and associations with disability are different between multiple sclerosis and neuromyelitis optica spectrum disorder

Spinal cord involvement by atrophy and associations with disability are different between multiple sclerosis and neuromyelitis optica spectrum disorder

Optic Chiasm Morphometric Changes in Multiple Sclerosis: Feasibility of a Simplified Brain Magnetic Resonance Imaging Measure of White Matter Atrophy

New MS diagnostic criteria in practice

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