The usefulness of brain MRI at onset in the differentiation of multiple sclerosis and seropositive neuromyelitis optica spectrum disorders

Background: Although neuromyelitis optica (NMO) is a central nervous system (CNS) autoimmune disease distinct from multiple sclerosis (MS). NMO and NMO spectrum disorder (NMOSD) sometimes show asymptomatic lesions on brain magnetic resonance imaging (MRI) at onset, and even present with symptomatic brain involvement. Objectives: We investigated whether brain MRI at onset can be helpful for the differentiation of MS and NMOSD. Methods: We retrospectively analyzed initial brain MRIs, performed within three months of onset, in patients with MS ( n = 51) and anti-aquaporin4-antibody-positive patients with NMOSD ( n = 67). Results: NMOSD patients met the Paty (37%) and Barkhof (13%) criteria, and the criteria of the European Magnetic Imaging in MS (MAGNIMS) study group (9%), for MS. Ovoid lesions perpendicular to the lateral ventricle, isolated juxtacortical lesions in U-fibers and isolated ovoid/round cortical lesions were found only in MS patients, whereas longitudinal corticospinal tract lesions, extensive hemispheric lesions, periependymal lesions surrounding the lateral ventricle and cervicomedullary lesions were found only in NMOSD patients. Conclusions: Our study suggests that it is difficult to differentiate MS from NMOSD by the fulfillment of the MRI criteria for MS on brain MRI at onset; however, the characteristic morphology of brain lesions is highly useful for the early differentiation of the two disorders.

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Relevance of hypointense brain MRI lesions for long-term worsening of clinical disability in relapsing multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458513494490 ◽

2013 ◽

Vol 20 (2) ◽

pp. 214-219 ◽

Cited By ~ 25

Author(s):

Antonio Giorgio ◽

Maria Laura Stromillo ◽

Maria Letizia Bartolozzi ◽

Francesca Rossi ◽

Marco Battaglini ◽

...

Keyword(s):

Multiple Sclerosis ◽

Brain Mri ◽

Univariate Analysis ◽

Brain Lesion ◽

Brain Magnetic Resonance Imaging ◽

Stepwise Multiple Regression ◽

Lesion Volume ◽

Magnetic Resonance Imaging Mri ◽

Relapsing Remitting Multiple Sclerosis

Background: The accrual of brain focal pathology is considered a good substrate of disability in relapsing–remitting multiple sclerosis (RRMS). However, knowledge on long-term lesion evolution and its relationship with disability progression is poor. Objective: The objective of this paper is to evaluate in RRMS the long-term clinical relevance of brain lesion evolution. Methods: In 58 RRMS patients we acquired, using the same scanner and protocol, brain magnetic resonance imaging (MRI) at baseline and 10±0.5 years later. MRI data were correlated with disability changes as measured by the Expanded Disability Status Scale (EDSS). Results: The annualized 10-year lesion volume (LV) growth was +0.25±0.5 cm3 (+6.7±8.7%) for T2-weighted (T2-W) lesions and +0.20±0.31 cm3 (+11.5±12.3%) for T1-weighted (T1-W) lesions. The univariate analysis showed moderate correlations between baseline MRI measures and EDSS at 10 years ( p < 0.001). Also, 10-year EDSS worsening correlated with LV growth and the number of new/enlarging lesions measured over the same period ( p < 0.005). In the stepwise multiple regression analysis, EDSS worsening over 10 years was best correlated with the combination of baseline T1-W lesion count and increasing T1-W LV ( R = 0.61, p < 0.001). Conclusion: In RRMS patients, long-term brain lesion accrual is associated with worsening in clinical disability. This is particularly true for hypointense, destructive lesions.

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Brain MRI in SARS-CoV-2 pneumonia patients with newly developed neurological manifestations suggestive of brain involvement

Scientific Reports ◽

10.1038/s41598-021-00064-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Batil Alonazi ◽

Ahmed M. Farghaly ◽

Mohamed A. Mostafa ◽

Jehad A. Al-Watban ◽

Salah A. Zindani ◽

...

Keyword(s):

Imaging Modality ◽

Brain Mri ◽

Brain Lesion ◽

Brain Magnetic Resonance Imaging ◽

Neurological Manifestations ◽

Rt Pcr ◽

Significant Difference ◽

Brain Involvement ◽

Magnetic Resonance Imaging Mri ◽

The Impact

AbstractThe increased frequency of neurological manifestations, including central nervous system (CNS) manifestations, in patients with coronavirus disease 2019 (COVID-19) pandemic is consistent with the virus's neurotropic nature. In most patients, brain magnetic resonance imaging (MRI) is a sensitive imaging modality in the diagnosis of viral encephalitides in the brain. The purpose of this study was to determine the frequency of brain lesion patterns on brain MRI in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia patients who developed focal and non-focal neurological manifestations. In addition, it will compare the impact of the Glasgow Coma Scale (GCS) as an index of deteriorating cerebral function on positive brain MRIs in both neurological manifestations. This retrospective study included an examination of SARS-CoV-2 pneumonia patients with real-time reverse transcription polymerase chain reaction (RT-PCR) confirmation, admitted with clinicoradiologic evidence of COVID-19 pneumonia, and who were candidates for brain MRI due to neurological manifestations suggesting brain involvement. Brain imaging acquired on a 3.0 T MRI system (Skyra; Siemens, Erlangen, Germany) with a 20-channel receive head coil. Brain MRI revealed lesions in 38 (82.6%) of the total 46 patients for analysis and was negative in the remaining eight (17.4%) of all finally enclosed patients with RT-PCR confirmed SARS-CoV-2 pneumonia. Twenty-nine (63%) patients had focal neurological manifestations, while the remaining 17 (37%) patients had non-focal neurological manifestations. The patients had a highly significant difference (p = 0.0006) in GCS, but no significant difference (p = 0.4) in the number of comorbidities they had. Brain MRI is a feasible and important imaging modality in patients with SARS-CoV-2 pneumonia who develop neurological manifestations suggestive of brain involvement, particularly in patients with non-focal manifestations and a decline in GCS.

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NMO-DBr: the Brazilian Neuromyelitis Optica Database System

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000500021 ◽

2011 ◽

Vol 69 (4) ◽

pp. 687-692 ◽

Cited By ~ 8

Author(s):

Marco A. Lana-Peixoto ◽

Lívia Edwiges Talim ◽

Alessandra C. Faria-Campos ◽

Sérgio V.A. Campos ◽

Cristiane F. Rocha ◽

...

Keyword(s):

Neuromyelitis Optica ◽

Brain Magnetic Resonance Imaging ◽

Database System ◽

Optic Coherence Tomography ◽

History Record ◽

Information Management Systems ◽

Associated Conditions ◽

Laboratory Information Management Systems ◽

Spectrum Disorders ◽

Magnetic Resonance Imaging Mri

OBJECTIVE: To present the Brazilian Neuromyelitis Optica Database System (NMO-DBr), a database system which collects, stores, retrieves, and analyzes information from patients with NMO and NMO-related disorders. METHOD: NMO-DBr uses Flux, a LIMS (Laboratory Information Management Systems) for data management. We used information from medical records of patients with NMO spectrum disorders, and NMO variants, the latter defined by the presence of neurological symptoms associated with typical lesions on brain magnetic resonance imaging (MRI) or aquaporin-4 antibody seropositivity. RESULTS: NMO-DBr contains data related to patient's identification, symptoms, associated conditions, index events, recurrences, family history, visual and spinal cord evaluation, disability, cerebrospinal fluid and blood tests, MRI, optic coherence tomography, diagnosis and treatment. It guarantees confidentiality, performs cross-checking and statistical analysis. CONCLUSION: NMO-DBr is a tool which guides professionals to take the history, record and analyze information making medical practice more consistent and improving research in the area.

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Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions

Multiple Sclerosis Journal ◽

10.1177/1352458518814117 ◽

2018 ◽

Vol 25 (14) ◽

pp. 1915-1925 ◽

Cited By ~ 24

Author(s):

Colm Elliott ◽

Jerry S Wolinsky ◽

Stephen L Hauser ◽

Ludwig Kappos ◽

Frederik Barkhof ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Magnetic Resonance ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Tissue Loss ◽

Jacobian Determinant ◽

Resonance Imaging ◽

T2 Lesions ◽

Magnetic Resonance Imaging Mri

Background: Chronic lesion activity driven by smoldering inflammation is a pathological hallmark of progressive forms of multiple sclerosis (MS). Objective: To develop a method for automatic detection of slowly expanding/evolving lesions (SELs) on conventional brain magnetic resonance imaging (MRI) and characterize such SELs in primary progressive MS (PPMS) and relapsing MS (RMS) populations. Methods: We defined SELs as contiguous regions of existing T2 lesions showing local expansion assessed by the Jacobian determinant of the deformation between reference and follow-up scans. SEL candidates were assigned a heuristic score based on concentricity and constancy of change in T2- and T1-weighted MRIs. SELs were examined in 1334 RMS patients and 555 PPMS patients. Results: Compared with RMS patients, PPMS patients had higher numbers of SELs ( p = 0.002) and higher T2 volumes of SELs ( p < 0.001). SELs were devoid of gadolinium enhancement. Compared with areas of T2 lesions not classified as SEL, SELs had significantly lower T1 intensity at baseline and larger decrease in T1 intensity over time. Conclusion: We suggest that SELs reflect chronic tissue loss in the absence of ongoing acute inflammation. SELs may represent a conventional brain MRI correlate of chronic active MS lesions and a candidate biomarker for smoldering inflammation in MS.

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Characteristic brain magnetic resonance imaging abnormalities in central nervous system aquaporin-4 autoimmunity

Multiple Sclerosis Journal ◽

10.1177/1352458510376640 ◽

2010 ◽

Vol 16 (10) ◽

pp. 1229-1236 ◽

Cited By ~ 121

Author(s):

Woojun Kim ◽

Min Su Park ◽

Sang Hyun Lee ◽

Su-Hyun Kim ◽

In Ja Jung ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Central Nervous System ◽

Nervous System ◽

Magnetic Resonance ◽

Neuromyelitis Optica ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Aquaporin 4 ◽

Resonance Imaging ◽

Brain Involvement

Background: Although neuromyelitis optica has been traditionally regarded as a disease without brain involvement, brain abnormalities are not uncommon in patients with neuromyelitis optica-related disorders. Methods: We aimed to characterize the brain magnetic resonance imaging (MRI) abnormalities in neuromyelitis optica spectrum disorder patients who are seropositive for anti-aquaporin-4 autoantibody (AQP4 Ab). Of 236 consecutive patients with inflammatory demyelinating central nervous system diseases, we retrospectively analyzed MRI characteristics of 78 patients who were seropositive for AQP4 Ab. Results: For an average observational period of 6.3 years, 62 patients (79%) had brain lesions on MRI. Twenty-four patients (31%) had brain MRI abnormalities at the onset of disease, and 35 (45%) had symptomatic brain involvement. Characteristic brain MRI abnormalities were classified into five categories: (1) lesions involving corticospinal tracts (e.g. posterior limb of internal capsule and cerebral peduncle (44%); (2) extensive hemispheric lesions likely due to vasogenic edema (29%); (3) periependymal lesions surrounding aqueduct and the third and fourth ventricles (22%); (4) periependymal lesions surrounding lateral ventricles (40%); and (5) medullary lesions, often contiguous with cervical lesions (31%). Fifty-four patients (69%) showed at least one kind of brain abnormality among the five characteristic MRI lesions. Ten patients showed gadolinium-enhancing lesions, which were characterized by multiple patchy enhancing patterns with blurred margins. Conclusions: In central nervous system AQP4 autoimmunity, brain MRI abnormalities were more common than is generally appreciated and were characterized by their unique localization and configuration.

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Neuromyelitis optica in Brazil: a study on clinical and prognostic factors

Multiple Sclerosis Journal ◽

10.1177/1352458508101935 ◽

2009 ◽

Vol 15 (5) ◽

pp. 613-619 ◽

Cited By ~ 46

Author(s):

DB Bichuetti ◽

EML Oliveira ◽

NA Souza ◽

RLM Rivero ◽

AA Gabbai

Keyword(s):

Neuromyelitis Optica ◽

Age Of Onset ◽

Care Center ◽

Brain Mri ◽

Tertiary Care ◽

Brain Magnetic Resonance Imaging ◽

Brain Lesions ◽

Relapsing Remitting ◽

First Relapse ◽

Magnetic Resonance Imaging Mri

Objectives To describe the clinical characteristics of patients with relapsing neuromyelitis optica (NMO) from a tertiary care center in Brazil and compare the groups with normal and abnormal brain magnetic resonance imaging (MRI). Methods Retrospective review of 41 patients followed at the Neuroimmunology Clinic of the Federal University of São Paulo, Brazil, from 1994 to 2007. Results All patients had relapsing-remitting optic-spinal disease, long extending spinal cord lesions, and brain MRI not meeting Barkhof criteria for multiple sclerosis (MS), thus fulfilling the 1999 and 2006 Wingerchuck criteria for NMO. Mean follow-up time was 52 months; mean age of onset was 32.6 years. The mean relapse rate (RR) and progression index (PI) were 1.0 and 0.9, respectively. Twenty-four patients had brain lesions not compatible with MS on MRI, and there were no statistical differences on PI and RR between patients who had brain lesions and patients who did not. Incomplete recovery, but not the type of first relapse, correlated with a worse prognosis. Seventeen patients were tested for NMO-IgG (anti-aquaporin-4 antibody) with 41% positivity. Conclusions In this series, we did not find a statistical difference of disease progression between patients with and without brain lesions, suggesting that the presence of brain abnormalities is not a marker of disease severity.

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NMO in pediatric patients: brain involvement and clinical expression

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000100008 ◽

2011 ◽

Vol 69 (1) ◽

pp. 34-38 ◽

Cited By ~ 17

Author(s):

Joaquín A. Peña ◽

María Elena Ravelo ◽

Eduardo Mora-La Cruz ◽

Cecilia Montiel-Nava

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Neuromyelitis Optica ◽

Optic Neuropathy ◽

Pediatric Patients ◽

Brain Mri ◽

Water Channel ◽

Suggested Method ◽

Clinical Expression ◽

Brain Involvement

OBJECTIVE: To analyze the clinical, neuroimaging characteristics and positivity of the acquaporin water channel (NMO-IgG) in pediatric patients with neuromyelitis optica (NMO). This disorder could have a variable clinical expression. To address such variability, the term NMO spectrum has been suggested. METHOD: We evaluated six pediatric patients, with a median age of 11 years at the time of the study, with the diagnosis of NMO by the Wingerchuck criteria. RESULTS: All the cases exhibited bilateral optic neuritis (ON). Four patients had abnormalities on brain MRI from the onset,although only three of them developed symptoms correlated to those lesions during the course of their disorder. NMO-IgG was positive in 80%. CONCLUSION: Optic neuropathy is the most impaired feature in NMO patients. Brain MRI lesions are not compatible with multiple sclerosis and positivity of the NMO-IgG are also present in NMO pediatric patients, confirming the heterogeneity in the expression of this disorder.

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Neuromyelitis optica: brain abnormalities in a Brazilian cohort

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000100001 ◽

2008 ◽

Vol 66 (1) ◽

pp. 1-4 ◽

Cited By ~ 21

Author(s):

Denis Bernardi Bichuetti ◽

René Leandro Magalhães Rivero ◽

Daniel May Oliveira ◽

Nilton Amorin de Souza ◽

Nitamar Abdala ◽

...

Keyword(s):

Neuromyelitis Optica ◽

Demyelinating Disease ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Radiological Features ◽

Relapsing Remitting ◽

Magnetic Resonance Imaging Mri ◽

Brazilian Cohort ◽

Abnormal Brain

Neuromyelitis optica (NMO) is a demyelinating disease consisting of relapsing-remitting optic neuritis and myelitis with a more severe course than Multiple Sclerosis. Recently, it has been shown that almost 50% of patients with NMO can have brain magnetic resonance imaging (MRI) abnormalities. We report on six Brazilian patients with NMO, fulfilling the 1999 Wingerchuck criteria for this disease, with abnormal brain MRI and discuss their clinical and radiological features.

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Brain magnetic resonance imaging findings in acute relapses of neuromyelitis optica spectrum disorders

Multiple Sclerosis Journal ◽

10.1177/1352458507082617 ◽

2007 ◽

Vol 14 (2) ◽

pp. 248-251 ◽

Cited By ~ 21

Author(s):

JA Cabrera-Gómez ◽

A. Saiz-Hinarejos ◽

F. Graus ◽

A. González-Quevedo ◽

R. Rodríguez-Rojas ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Neuromyelitis Optica ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Transverse Myelitis ◽

Resonance Imaging ◽

Igg Antibody ◽

Magnetic Resonance Imaging Mri ◽

Extensive Transverse Myelitis

We studied cranial magnetic resonance imaging (MRI) lesions in three women with acute attacks of recurrent longitudinally extensive transverse myelitis (r-LETM), recurrent-optic neuritis (r-ON) and r-LETM-CNS. Neuromyelitis Optica -immunoglobulin (IgG) antibody was positive in all cases. Brain MRI (1.5 Tesla) was performed according to protocol from consortium MS centre. We described the cranial lesions in brain MRI of acute relapses. These lesions were different from MS, most had an asymptomatic course which disappeared with time, protocol from consortium of MS centre criteria for brain MRI and seropositivity of NMO-IgG are useful tools for differentiate acute lesions of NMO/MS. Multiple Sclerosis 2008; 14: 248—251. http://msj.sagepub.com

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The influence of slice orientation on brain MRI lesion load measurement in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/135245859700300604 ◽

1997 ◽

Vol 3 (6) ◽

pp. 382-384

Author(s):

M. Rovaris ◽

MP Sormanis ◽

MA Rocca ◽

G. Comi ◽

M. Filippi

Keyword(s):

Multiple Sclerosis ◽

Spin Echo ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Lesion Load ◽

Conventional Mri ◽

Slice Orientation ◽

Mri Scans ◽

The Mean ◽

Magnetic Resonance Imaging Mri

This study aimed at evaluating the influence of a different slice orientation on brain magnetic resonance imaging (MRI) lesion load in multiple sclerosis (MS). Fifteen MS patients were scanned obtaining both axial and sagittal conventional spin echo (24 slices; TR 2400, TE 30/80) brain MRI. The total lesion load (TLL) was assessed twice for each scan, using a semi-automated local thresholding technique and the same marked hardcopies. The mean TLL was 22734 mm3 for axial and 22003 mm3 for sagittal scans. The mean intra-observer coefficient of variation (COV) was 4.65% for the axial acquisitions and 4.52% for the sagittal acquisitions. This difference was not statistically significant (one-way ANOVA, P> 0.1). The lesion load was significantly higher from axial MRI as compared to the intra-observer variability (two-way ANOVA, P =0.01), but the fluctuations around this average difference between axial and sagittal scan TLL were significantly large (test for interaction, P < 0.00I). Our data indicate that the use of sagittal conventional MRI scans does not seem to be worthwhile for the quantitative assessment of lesion load in MS patients.

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