Research: Distinguishing NMO from MS

Epub: Sinnecker et al. Distinct lesion morphology at 7-T MRI differentiates neuromyelitis optica from multiple sclerosis. Neurology. 2012 Aug 1

OBJECTIVE: To investigate distinct white matter and cortical gray matter pathology in neuromyelitis optica spectrum disorders (NMOSDs) and MS at 7-T MRI in a cross-sectional study.

 "Tesla is the unit we use to describe the strength of the magnet. 7 Tesla is the strongest magnet in clinical use at the present time for research. Believe me when I say it is a vey powerful magnet."

METHODS: This study included 10 subjects with NMOSDs and 18 MSers. The imaging protocol comprised T2*-weighted fast low angle shot and turbo inversion recovery magnitude sequences. White matter and cortical gray matter lesions were assessed with special regard to their (perivascular) localization as well as the expression of a hypointense rim.

 "Don't worry if you don't understand the MRI sequences; all the are describing is a the settings on the MRI machine that result in different types of data or images being formed."

RESULTS: In total, they detected 140 white matter lesions in 7 of 10 patients with NMOSDs. In contrast to MS plaques, which were nearly exclusively centered by a small vein (92%) and showed a characteristic hypointense (less dense) rim (23%), white matter changes in NMOSDers were nonspecific in appearance and were only infrequently neighboured by a blood vessel (49 lesions [35%], p = 0.003). Hypointense rims were very rarely detectable (3 lesions [2%], p < 0.001). Cortical pathology was absent in NMOSDs. In this MS cohort, they detected 36 leukocortical, 8 intracortical, and 8 subpial cortical lesions in 7 of 18 MSers.

CONCLUSION: The MRI features of white matter and the absence of cortical gray matter findings substantially differentiate NMOSDs from MS and can be used as a potential marker to distinguish these 2 entities. The fact that cortical pathology is common in MS but is not present in patients with NMOSDs may reflect the difference in the underlying pathogenesis.

 
"Most NMOers have antibodies to a protein, aquaporin 4, and require a different treatment to MSers. Methods to distinguish these different neurological diseases is important clinically. This study using a high power MRI appears to be able to distinguish NMOers from MSers; MSers have grey matter lesions, lesions with a hypointense border, which represents demyelination, and lesion centred on veins. You can read a prvious post to reaquaint your self with the different types of grey matter lesions."

"If these findings are confirmed this study will lead to 7Tesla MRIs being introduced to routine clinical practice sooner than we expected."

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