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Comparative Study
. 2011;6(8):e22766.
doi: 10.1371/journal.pone.0022766. Epub 2011 Aug 10.

Comparative brain stem lesions on MRI of acute disseminated encephalomyelitis, neuromyelitis optica, and multiple sclerosis

Zhengqi Lu  1 , Bingjun Zhang, Wei Qiu, Zhuang Kang, Liping Shen, Youming Long, Junqi Huang, Xueqiang Hu
Affiliations
Comparative Study

Comparative brain stem lesions on MRI of acute disseminated encephalomyelitis, neuromyelitis optica, and multiple sclerosis

Zhengqi Lu et al. PLoS One. 2011.

Abstract

Background: Brain stem lesions are common in patients with acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and multiple sclerosis (MS).

Objectives: To investigate comparative brain stem lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, NMO, and MS.

Methods: Sixty-five adult patients with ADEM (n = 17), NMO (n = 23), and MS (n = 25) who had brain stem lesions on MRI were enrolled. Morphological features of brain stem lesions among these diseases were assessed.

Results: Patients with ADEM had a higher frequency of midbrain lesions than did patients with NMO (94.1% vs. 17.4%, P<0.001) and MS (94.1% vs. 40.0%, P<0.001); patients with NMO had a lower frequency of pons lesions than did patients with MS (34.8% vs. 84.0%, P<0.001) and ADEM (34.8% vs. 70.6%, P = 0.025); and patients with NMO had a higher frequency of medulla oblongata lesions than did patients with ADEM (91.3% vs. 35.3%, P<0.001) and MS (91.3% vs. 36.0%, P<0.001). On the axial section of the brain stem, the majority (82.4%) of patients with ADEM showed lesions on the ventral part; the brain stem lesions in patients with NMO were typically located in the dorsal part (91.3%); and lesions in patients with MS were found in both the ventral (44.0%) and dorsal (56.0%) parts. The lesions in patients with ADEM (100%) and NMO (91.3%) had poorly defined margins, while lesions of patients with MS (76.0%) had well defined margins. Brain stem lesions in patients with ADEM were usually bilateral and symmetrical (82.4%), while lesions in patients with NMO (87.0%) and MS (92.0%) were asymmetrical or unilateral.

Conclusions: Brain stem lesions showed various morphological features among adult patients with ADEM, NMO, and MS. The different lesion locations may be helpful in distinguishing these diseases.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Brain stem lesions (arrows) on MRI of acute disseminated encephalomyelitis (ADEM).
(A, B) Fluid-attenuated inversion recovery (FLAIR) image showing midbrain lesions with poorly defined margins located in the ventral part (symmetrical or bilateral). (C, D) Sagittal image highlighting multiple brain stem lesions (midbrain, pons, medulla) with poorly defined margins.
Figure 2
Figure 2. Brain stem lesions (arrows) on MRI of neuromyelitis optica (NMO).
(A) MRI showing medulla lesion located in the dorsal part with poorly defined shape. (B) MRI showing linear medullospinal lesions. (C) MRI showing distribution of NMO-characteristic brain lesions (dorsal brain stem) corresponding to sites of high NMO-IgG expression.
Figure 3
Figure 3. Brain stem lesions (arrows) on MRI of multiple sclerosis (MS).
(A, B) MRI showing solitary pons lesion with sharply defined borders. (C) MRI showing midbrain lesions.
See this image and copyright information in PMC

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