TY - JOUR
T1 - Longitudinally extensive optic neuritis as an MRI biomarker distinguishes neuromyelitis optica from multiple sclerosis
AU - Mealy, Maureen A.
AU - Whetstone, Anna
AU - Orman, Gunes
AU - Izbudak, Izlem
AU - Calabresi, Peter A.
AU - Levy, Michael
N1 - Funding Information:
Dr. Levy receives research support from NIH, Guthy Jackson Charitable Foundation, Viropharma, Acorda, Sanofi, NeuralStem and Genentech, and serves as a consultant for Chugai Pharmaceuticals, GlaxoSmithKline and Medimmune.
Funding Information:
Dr. Calabresi has received personal compensation for consulting and serving on scientific advisory boards from Vertex, Vaccinex, Medimmune, Prothena, and Abbott; and has received research funding from companies Biogen-IDEC and Novartis.
Publisher Copyright:
© 2015 Elsevier B.V. All rights reserved.
PY - 2015/8/15
Y1 - 2015/8/15
N2 - Objective To differentiate MRI characteristics of optic neuritis associated with neuromyelitis optica (NMO) and relapsing remitting multiple sclerosis (RRMS). Background Optic neuritis is a common presenting feature of both neuromyelitis optica and multiple sclerosis. Distinguishing between NMO and RRMS is important in guiding treatment, but biomarkers of NMO and MS can be absent early in the disease process. We looked for differences in MRI characteristics of optic neuritis associated with NMO and MS that provide an early clue in the diagnostic workup. Design/Methods We conducted a retrospective analysis of 26 NMO and 26 RRMS patients presenting to the Johns Hopkins Hospital with MRI-confirmed acute optic neuritis. MRIs were assessed to identify the location and longitudinal extent of each contrast enhancing lesion. For the purposes of this study, the optic nerve was divided into intraorbital, canalicular, pre-chiasmal, chiasmal, and optic tract. Results There are distinct differences in MRI characteristics between NMO- and RRMS-associated optic neuritis. The majority of NMO lesions were longitudinally extensive measuring at least 17.6 mm in length and involving at least three optic nerve segments. At a cutoff of 17.6 mm lesion length, the specificity for NMO is 76.9% with a sensitivity of 80.8% and positive likelihood ratio of 3.50. Conversely, MS lesions were more commonly focal in one optic nerve segment localized anteriorly. Conclusions Optic neuritis in NMO has a distinct pattern on MRI as compared with RRMS and can help differentiate these two neuroinflammatory diseases at presentation.
AB - Objective To differentiate MRI characteristics of optic neuritis associated with neuromyelitis optica (NMO) and relapsing remitting multiple sclerosis (RRMS). Background Optic neuritis is a common presenting feature of both neuromyelitis optica and multiple sclerosis. Distinguishing between NMO and RRMS is important in guiding treatment, but biomarkers of NMO and MS can be absent early in the disease process. We looked for differences in MRI characteristics of optic neuritis associated with NMO and MS that provide an early clue in the diagnostic workup. Design/Methods We conducted a retrospective analysis of 26 NMO and 26 RRMS patients presenting to the Johns Hopkins Hospital with MRI-confirmed acute optic neuritis. MRIs were assessed to identify the location and longitudinal extent of each contrast enhancing lesion. For the purposes of this study, the optic nerve was divided into intraorbital, canalicular, pre-chiasmal, chiasmal, and optic tract. Results There are distinct differences in MRI characteristics between NMO- and RRMS-associated optic neuritis. The majority of NMO lesions were longitudinally extensive measuring at least 17.6 mm in length and involving at least three optic nerve segments. At a cutoff of 17.6 mm lesion length, the specificity for NMO is 76.9% with a sensitivity of 80.8% and positive likelihood ratio of 3.50. Conversely, MS lesions were more commonly focal in one optic nerve segment localized anteriorly. Conclusions Optic neuritis in NMO has a distinct pattern on MRI as compared with RRMS and can help differentiate these two neuroinflammatory diseases at presentation.
KW - Aquaporin-4
KW - Bilateral optic neuritis
KW - Longitudinally extensive optic neuritis
KW - MRI
KW - Neuromyelitis optica
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U2 - 10.1016/j.jns.2015.05.013
DO - 10.1016/j.jns.2015.05.013
M3 - Article
C2 - 26026942
AN - SCOPUS:84937516696
VL - 355
SP - 59
EP - 63
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
SN - 0022-510X
IS - 1-2
ER -