Yeliz Pekcevik1, Charles H Mitchell1, Maureen A Mealy2, Gunes Orman1, In H Lee3, Scott D Newsome4, Carol B Thompson5, Carlos A Pardo4, Peter A Calabresi6, Michael Levy7, Izlem Izbudak8. 1. Russell H Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA. 2. Johns Hopkins Transverse Myelitis and Multiple Sclerosis Centers, Baltimore, MD, USA. 3. Russell H Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA/Department of Radiology, Chungnam National University Hospital, Daejeon, Korea. 4. Division of Neuroimmunology and Neuroinfectious Diseases, Johns Hopkins Hospital, Baltimore, MD, USA. 5. Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA. 6. Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA. 7. Department of Neurology, Johns Hopkins Hospital, Neuromyelitis Optica Clinic Baltimore, MD, USA. 8. Russell H Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA iizbuda1@jhmi.edu.
Abstract
BACKGROUND: Although spinal magnetic resonance imaging (MRI) findings of neuromyelitis optica (NMO) have been described, there is limited data available that help differentiate NMO from other causes of longitudinally extensive transverse myelitis (LETM). OBJECTIVE: To investigate the spinal MRI findings of LETM that help differentiate NMO at the acute stage from multiple sclerosis (MS) and other causes of LETM. METHODS: We enrolled 94 patients with LETM into our study. Bright spotty lesions (BSL), the lesion distribution and location were evaluated on axial T2-weighted images. Brainstem extension, cord expansion, T1 darkness and lesion enhancement were noted. We also reviewed the brain MRI of the patients during LETM. RESULTS: Patients with NMO had a greater amount of BSL and T1 dark lesions (p < 0.001 and 0.003, respectively). The lesions in NMO patients were more likely to involve greater than one-half of the spinal cord's cross-sectional area; to enhance and be centrally-located, or both centrally- and peripherally-located in the cord. Of the 62 available brain MRIs, 14 of the 27 whom were NMO patients had findings that may be specific to NMO. CONCLUSIONS: Certain spinal cord MRI features are more commonly seen in NMO patients and so obtaining brain MRI during LETM may support diagnosis.
BACKGROUND: Although spinal magnetic resonance imaging (MRI) findings of neuromyelitis optica (NMO) have been described, there is limited data available that help differentiate NMO from other causes of longitudinally extensive transverse myelitis (LETM). OBJECTIVE: To investigate the spinal MRI findings of LETM that help differentiate NMO at the acute stage from multiple sclerosis (MS) and other causes of LETM. METHODS: We enrolled 94 patients with LETM into our study. Bright spotty lesions (BSL), the lesion distribution and location were evaluated on axial T2-weighted images. Brainstem extension, cord expansion, T1 darkness and lesion enhancement were noted. We also reviewed the brain MRI of the patients during LETM. RESULTS:Patients with NMO had a greater amount of BSL and T1 dark lesions (p < 0.001 and 0.003, respectively). The lesions in NMO patients were more likely to involve greater than one-half of the spinal cord's cross-sectional area; to enhance and be centrally-located, or both centrally- and peripherally-located in the cord. Of the 62 available brain MRIs, 14 of the 27 whom were NMO patients had findings that may be specific to NMO. CONCLUSIONS: Certain spinal cord MRI features are more commonly seen in NMO patients and so obtaining brain MRI during LETM may support diagnosis.
Authors: S M Magaña; M Matiello; S J Pittock; A McKeon; V A Lennon; A A Rabinstein; E Shuster; O H Kantarci; C F Lucchinetti; B G Weinshenker Journal: Neurology Date: 2009-02-24 Impact factor: 9.910
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