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. 2012 Winter;14(4):209-14.
doi: 10.7224/1537-2073-14.4.209.

Differentiation of neuromyelitis optica from multiple sclerosis on spinal magnetic resonance imaging

Saurabh Lalan  1 , Majid Khan  1 , Bruce Schlakman  1 , Alan Penman  1 , Joseph Gatlin  1 , Robert Herndon  1
Affiliations

Differentiation of neuromyelitis optica from multiple sclerosis on spinal magnetic resonance imaging

Saurabh Lalan et al. Int J MS Care. 2012 Winter.

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.

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Figures

Figure 1.
Figure 1.
Axial T2 fast spin echo (A) and axial T2 gradient (B) images of the cervical cord showing central T2 hyperintensity (arrows) in neuromyelitis optica involving central portions of the spinal cord with signal changes involving more than 50% of the cross-sectional area
Figure 2.
Figure 2.
Sagittal T2 fast spin echo images of the cervical (A, B) and thoracic (C) spine showing continuous long-segment linear T2 signal hyperintensity (arrows) involving the spinal cord extending from the cervicomedullary junction to the T8-9 level with predominantly central involvement of the cord in a patient with neuromyelitis optica
Figure 3.
Figure 3.
Axial T2 fast spin echo (A, B) and sagittal short tau inversion recovery (STIR) (C) sequences showing the typical peripheral signal changes on axial images (A, B) and discontinuous high T2 signal (arrows) involving short segments of the spinal cord (C) in a patient with multiple sclerosis
See this image and copyright information in PMC

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