TY - JOUR
T1 - Brain MRI findings in pediatric-onset neuromyelitis optica spectrum disorder
T2 - Challenges in differentiation from acute disseminated encephalomyelitis
AU - Bulut, E.
AU - Karakaya, J.
AU - Salama, S.
AU - Levy, M.
AU - Huisman, T. A.G.M.
AU - Izbudak, I.
N1 - Funding Information:
Disclosures: Thierry A.G.M. Huisman—UNRELATED: Board Membership: American Journal of Neuroradiology Senior Editor. Izlem Izbudak—UNRELATED: Consultancy: Alexion Pharmaceuticals, Comments: reviewing MRI spine examinations of patients with neuromyelitis optica for adjudication about recurrence findings on MRI as part of an NMO trial; Grants/Grants Pending: Biogen, Comments: MS PATHS study site.* Sara Salama—RELATED: Grant: Ministry of Higher Education, Egypt, Comments: The Joint Supervision Scholarship number is JS-3725. Michael Levy— UNRELATED: Consultancy: Alexion Pharmaceuticals, Quest Diagnostics; Expert Testimony: various law firms; Grants/Grants Pending: National Institutes of Health, National MS Society.* *Money paid to the institution.
Publisher Copyright:
© 2019 American Society of Neuroradiology. All Rights Reserved.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - 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.
AB - 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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U2 - 10.3174/ajnr.A6003
DO - 10.3174/ajnr.A6003
M3 - Article
C2 - 30846436
AN - SCOPUS:85064531018
SN - 0195-6108
VL - 40
SP - 726
EP - 731
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
IS - 4
ER -