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Published on: April 14, 2014
Brain magnetic resonance imaging findings in relapsing neuromyelitis optica
José A Cabrera-Gómez1, L Quevedo-Sotolongo, A González-Quevedo
1International Center of Neurological Restoration, Reparto Cubanacán, Playa, Ciudad de La Habana, Cuba. cabrera.gomez@infomed.sld.cu
Background:
Some studies showed abnormalities in brain magnetic resonance imaging (MRI) of relapsing neuromyelitis optica (R-NMO) from 12 to 46%. These abnormalities are described as compatible/non-compatible with multiple sclerosis (MS).
Objective:
To describe the abnormal brain MRI lesions in R-NMO with imaging studies conducted with more sensitive white matter change techniques.
Methods:
Thirty patients with R-NMO were selected. All MRI brain studies were performed with a 1.5-T Siemens MRI system according to the Standardized MR Imaging Protocol for Multiple Sclerosis from the Consortium of MS Centers Consensus Guidelines.
Results:
Brain MRI images were evaluated in 29 R-NMO cases because in one case the MRI images were not appropriate for the study. Of these 29 brain MRI studies, 19 cases (65.5%) had at least one or more lesions (1-57) and 10 were negative (34.4%). Brain MRI findings in 19 cases were characterized in T2/fluid-attenuated inversion-recovery (FLAIR) by the presence of subcortical/deep white matter lesions in 16 (84.2%) cases (1-50), most of them <3 mm and without juxtacortical localization. Periventricular lesions were observed in 13 (68.4%) cases, but morphologically they were not oval, ovoid or perpendicularly orientated. Infratentorial lesions, all >3 mm, were observed in 4 (21.05%) cases without cerebellar involvement. T1 studies demonstrated absence of hypointense regions. Optic nerve enhancement was observed in 6/19 patients (31.5%). None of the brain MRI abnormalities observed were compatible with Barkhof et al. criteria of MS.
Conclusions:
This study, based on a Cuban patient population, with long duration of disease, good sample size and detailed characterization by MRI, demonstrated the brain MRI pattern of R-NMO patients, which is different from MS.
Insights
Brain MRI in relapsing neuromyelitis optica (R-NMO) shows distinct lesions not compatible with multiple sclerosis (MS). This study details R-NMO brain MRI patterns using advanced techniques.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Brain magnetic resonance imaging (MRI) in relapsing neuromyelitis optica (R-NMO) can present abnormalities, with previous studies reporting frequencies between 12% and 46%.
- These reported abnormalities have been variably described as compatible or non-compatible with multiple sclerosis (MS).
Purpose of the Study:
- To characterize abnormal brain MRI lesions in relapsing neuromyelitis optica (R-NMO) using advanced white matter imaging techniques.
- To differentiate R-NMO brain MRI findings from those typically seen in multiple sclerosis (MS).
Main Methods:
- Thirty patients diagnosed with R-NMO were included in the study.
- All brain MRI scans were acquired using a 1.5-T Siemens MRI system, adhering to the Standardized MR Imaging Protocol for Multiple Sclerosis guidelines.
Main Results:
- Out of 29 evaluated R-NMO brain MRIs, 19 cases (65.5%) exhibited lesions, while 10 (34.4%) were negative.
- Lesions were predominantly subcortical/deep white matter (84.2%), often small (<3 mm), and lacked juxtacortical or typical MS-compatible morphology.
- Optic nerve enhancement occurred in 31.5% of cases, and no observed brain MRI abnormalities met the Barkhof criteria for MS.
Conclusions:
- This detailed MRI characterization in a Cuban R-NMO patient cohort reveals a distinct brain MRI pattern that differentiates it from multiple sclerosis (MS).
- The findings highlight the utility of advanced MRI techniques in distinguishing R-NMO from MS, aiding in accurate diagnosis and management.
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