Brain MRI findings in pediatric-onset neuromyelitis optica spectrum disorder

Challenges in differentiation from acute disseminated encephalomyelitis

E. Bulut, J. Karakaya, S. Salama, Michael Levy, T. A.G.M. Huisman, Izlem Izbudak

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Differentiating pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis could be challenging, especially in cases presenting with only brain manifestations. Our purpose was to investigate brain MR imaging features that may help distinguish these 2 entities. MATERIALS AND METHODS: We retrospectively examined initial brain MR imaging studies of 10 patients with pediatric-onset neuromyelitis optica spectrum disorder (female/male ratio, 7:3) and 10 patients with acute disseminated encephalomyelitis (female/male ratio, 2:8). The mean age of the patients was 10.3 5.6 and 8.7 5.3 years, respectively. Brain lesions were evaluated with respect to location, extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. The 2 test (Yates or Fisher exact 2 tests) was used to compare differences between groups. RESULTS: Cerebral subcortical juxtacortical and pons middle cerebellar peduncle were the most frequent locations involved in both neuromyelitis optica spectrum disorder (n 5 and 4, respectively) and acute disseminated encephalomyelitis (n 9 and 7, respectively). Thalamic lesions were more frequent in acute disseminated encephalomyelitis (P .020) and were detected only in 1 patient with neuromyelitis optica spectrum disorder. None of the patients with neuromyelitis optica spectrum disorder had hypothalamic, internal capsule, or cortical lesions. The internal capsule involvement was found to be significantly different between groups (P .033). There was no significant difference in terms of extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. CONCLUSIONS: Although there is a considerable overlap in brain MR imaging findings, thalamic and internal capsule involvement could be used to differentiate pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis.

Original languageEnglish (US)
Pages (from-to)726-731
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume40
Issue number4
DOIs
StatePublished - Apr 1 2019

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Acute Disseminated Encephalomyelitis
Neuromyelitis Optica
Pediatrics
Internal Capsule
Brain
Neuroimaging
Pons

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Brain MRI findings in pediatric-onset neuromyelitis optica spectrum disorder : Challenges in differentiation from acute disseminated encephalomyelitis. / Bulut, E.; Karakaya, J.; Salama, S.; Levy, Michael; Huisman, T. A.G.M.; Izbudak, Izlem.

In: American Journal of Neuroradiology, Vol. 40, No. 4, 01.04.2019, p. 726-731.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND AND PURPOSE: Differentiating pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis could be challenging, especially in cases presenting with only brain manifestations. Our purpose was to investigate brain MR imaging features that may help distinguish these 2 entities. MATERIALS AND METHODS: We retrospectively examined initial brain MR imaging studies of 10 patients with pediatric-onset neuromyelitis optica spectrum disorder (female/male ratio, 7:3) and 10 patients with acute disseminated encephalomyelitis (female/male ratio, 2:8). The mean age of the patients was 10.3 5.6 and 8.7 5.3 years, respectively. Brain lesions were evaluated with respect to location, extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. The 2 test (Yates or Fisher exact 2 tests) was used to compare differences between groups. RESULTS: Cerebral subcortical juxtacortical and pons middle cerebellar peduncle were the most frequent locations involved in both neuromyelitis optica spectrum disorder (n 5 and 4, respectively) and acute disseminated encephalomyelitis (n 9 and 7, respectively). Thalamic lesions were more frequent in acute disseminated encephalomyelitis (P .020) and were detected only in 1 patient with neuromyelitis optica spectrum disorder. None of the patients with neuromyelitis optica spectrum disorder had hypothalamic, internal capsule, or cortical lesions. The internal capsule involvement was found to be significantly different between groups (P .033). There was no significant difference in terms of extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. CONCLUSIONS: Although there is a considerable overlap in brain MR imaging findings, thalamic and internal capsule involvement could be used to differentiate pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis.",
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