J Korean Soc Radiol.  2013 May;68(5):375-383.

Magnetic Resonance Imaging Features of Neuromyelitis Optica

Affiliations
  • 1Department of Radiology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea. cjsong@cnu.ac.kr
  • 2Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea.

Abstract

PURPOSE
To report the magnetic resonance (MR) imaging features of the spinal cord and brain in patients of neuromyelitis optica (NMO).
MATERIALS AND METHODS
Between January 2001 and March 2010, the MR images (spinal cord, brain, and orbit) and the clinical and serologic findings of 11 NMO patients were retrospectively reviewed. The contrast-enhancement of the spinal cord was performed (20/23). The presence and pattern of the contrast-enhancement in the spinal cord were classified into 5 types.
RESULTS
Acute myelitis was monophasic in 8 patients (8/11, 72.7%); and optic neuritis preceded acute myelitis in most patients. Longitudinally extensive cord lesion (average, 7.3 vertebral segments) was involved. The most common type was the diffuse and subtle enhancement of the spinal cord with a multifocal nodular, linear or segmental intense enhancement (45%). Most of the brain lesions (5/11, 10 lesions) were located in the brain stem, thalamus and callososeptal interphase. Anti-Ro autoantibody was positive in 2 patients, and they showed a high relapse rate of acute myelitis. Anti-NMO IgG was positive in 4 patients (4/7, 66.7%).
CONCLUSION
The imaging findings of acute myelitis in NMO may helpful in making an early diagnosis of NMO which can result in a severe damage to the spinal cord, and to make a differential diagnosis of multiple sclerosis and inflammatory diseases of the spinal cord such as toxocariasis.


MeSH Terms

Brain
Brain Stem
Diagnosis, Differential
Early Diagnosis
Humans
Immunoglobulin G
Interphase
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Multiple Sclerosis
Myelitis
Neuromyelitis Optica
Optic Neuritis
Recurrence
Retrospective Studies
Sjogren's Syndrome
Spinal Cord
Spine
Thalamus
Toxocariasis
Immunoglobulin G

Figure

  • Fig. 1 Type of enhancement pattern of spinal cord on sagittal image. Type A. No enhancement. Type B. Subtle diffuse heterogenous contrast-enhancement without solitary or multiple strong contrast-enhancing foci. Type C. Subtle diffuse enhancement wit h strong solitary nodular- or tumefactive peripheral rim-enhancing foci. Type Da. Subtle diffuse enhancement with multiple posterior nodular enhancement foci. Type Db. Subtle diffuse enhancement with multiple posterior continuous longitudinal enhancement foci. Type Dc. Subtle diffuse enhancement with multiple central nodular enhancement foci. Type E. Diffuse strong contrast enhancement without disruption.

  • Fig. 2 Type B. 1st attack of acute myelitis in patient 7. Contrasted enhanced T1-weighted sagittal image shows subtle diffuse heterogeneous contrast enhancement. There are no solitary or multiple nodular enhancement.

  • Fig. 3 Type C. 10th attack of acute myelitis in patient 5. A. T2-weighted image shows high signal intensity in the cervical cord at the level of C1-2 (arrow). B, C. Contrasted enhanced T1-weighted sagittal (arrow) and axial image (arrow) shows tumefactive peripheral rim enhancing nodular lesion at C1-2.

  • Fig. 4 Type D acute myelitis in patient 3 and 5. A, B. Type Da. At 5th attack of aucte myelitis in patient 5, contrast-enhanced T1-weighted sagittal image shows multifocal nodular (arrows) and continuous longitudinal enhancement (empty arrows in B) mainly along the posterior aspect of cervical and upper thoracic spinal cord. C, D. Type Db. At 5th attack of acute myelitis in patient 3, contrast-enhanced T1-weighted sagittal image shows multiple continuous longitudinal enhancement (arrows) along the spinal cord at C1 to C2 (C). Simultaneously the similar lesion were along the spinal cord at T4-T6 (arrows) (D). E, F. Type Dc. At 1st attack of acute myelitis in patient 3, contrast-enhanced T1-weighted sagittal and axial image shows nodular enhancement (arrow) in central portion of thoracic spinal cord at the level of T4.

  • Fig. 5 Type E. Acute myelitis in patient 2, without recurrence of acute myelitis. Contrast-enhanced T1-weighted sagittal image shows subtle diffuse contrast-enhancement in whole spinal cord (arrows) with diffuse strong contrast-enhancement.

  • Fig. 6 Variable located high signal intensity lesions of the brain on fluid attenuated inversion recovery (FLAIR) or T2-weighted image in patient 7 (A-C) and patient 6 (D). A. T2-weighted axial image shows focal high signal intensity (SI) in medulla oblongata. B. FLAIR axial image shows high SI in left periventricular white matter. C. FLAIR sagittal image shows edematous white matter lesions involving the corpus callosum, particularly the splenium. D. FLAIR axial image shows high signal intensity lesion in periaqueductal area of midbrain.

  • Fig. 7 In patient 2, optic neuritis at first attack. T2-weighted axial image (A) shows high-signal intensity foci in the minimally expanded left optic nerve. These lesion enhances following intravenous contrast administration on fat saturated T1-weighted image (B).


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