Neuromyelitis optica (NMO): radiological differential from MS

Evidence-based neurology checklist on neuromyelitis optica (nmo): radiological differential from ms: Lesions typically seen in MS Ovoid lesions perpendicular to the lateral ventricle Round or ovoid cortical lesions Isolated juxtacortical or U fiber lesions Midbrain and pontine atrophy Central vein…

Lesions typically seen in MS

  • Ovoid lesions perpendicular to the lateral ventricle
  • Round or ovoid cortical lesions
  • Isolated juxtacortical or U fiber lesions
  • Midbrain and pontine atrophy
  • Central vein sign (CVS) on T3 MRI
  • Rim-like or nodular paramagnetic phase changes on T7 MRI
  • Involvement of the choroid plexus: the volume is larger than in NMO

Lesions typically seen in NMO

References

  1. Huh SY, Min JH, Kim W, et al. The usefulness of brain MRI at onset in the differentiation of multiple sclerosis and seropositive neuromyelitis optica spectrum disorders. Mult Scler 2014; 20:695-704. 
  2. Cortese R, Prados Carrasco F, Tur C, et al. Differentiating multiple sclerosis from AQP4-neuromyelitis optica spectrum disorder and MOG-antibody disease with imaging. Neurology 2023; 100:e308-e323. 
  3. Lee CY, Mak HK, Chiu PW, Chang HC, Barkhof F, Chan KH. Differential brainstem atrophy patterns in multiple sclerosis and neuromyelitis optica spectrum disorders. J Magn Reson Imaging 2018; 47:1601-1609.
  4. Cortese R, Magnollay L, Tur C, et al. Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD. Neurology 2018; 90:e1183-e1190. 
  5. Sinnecker T, Schumacher S, Mueller K, et al. MRI phase changes in multiple sclerosis vs neuromyelitis optica lesions at 7T. Neurol Neuroimmunol Neuroinflamm 2016; 3:e259.
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