TheImportanceofBeingEarnestinDifferentiatingNMOSDfromMS

AtkinsonMorleyWing,St.GeorgesHospital,London,UK

DrAdamYoussef,DrAudreySinclair,DrDeclanJohnson

鉴别视神经脊髓炎谱系疾病(NMOSD)和多发性硬化(MS)的重要意义

?DistinguishingNMOSD(NeuromyelitisOpticaSpectrumDisorder)fromMSandCNSinflammatorymimicshasimportanttherapeutic治疗andprognostic预后implicationsandisrevolutionisingmanagement

?MRIcharacterisationandbiomarker生物标记物discoverieshaveincreasedourunderstandingofCNSinflammatorydisorders

Teachingpoints:

IdentifytypicalMRIpatternsofNMOSDasopposedtoMS

NeuroimagingfindingsinNMOSDasopposedtoMS

ClinicalandNeuroimagingdifferencesinMSanddifferentsubtypesofNMOSD

Caseexamples

Differential/Mimics

Treatmentandprognosis

Terminology:

★Disseminationinspace空间上传播:ThedevelopmentoflesionsindistinctanatomicallocationswithintheCNS-i.e.indicatingamultifocalCNSprocess.

★Disseminationintime时间上传播:ThedevelopmentorappearanceofnewCNSlesionsovertime.

★Infratentorial幕下的MRIlesion:AT2-hyperintenselesioninthebrainstem(typicallynearthesurface),cerebellarpeduncles小脑脚,orcerebellum.

★Juxtacortical近皮质的MRIlesion:AT2-hyperintensecerebralwhitematterlesionabuttingthecortex皮质andnotseparatedbywhitematter.

★DeepGreymatterMRIlesion:AT2-hyperintenselesionofthedeepgreymatterstructuresseenonT2.

★CorticalMRIlesions:Lesionswithinthecerebralcortex大脑皮质.Typically,specialMRltechniquesarerequiredtovisualisetheselesions.Careisneededtodistinguishpotentialcorticallesionsfromneuroimagingartefacts神经影像伪影.

★Periventricular脑室周围MRIlesion:AT2-hyperintensecerebralwhitematterlesionabuttingthelateralventricles侧脑室withoutwhitematterinbetween,includinglesionsinthecorpuscallosum胼胝体butexcludinglesionsindeepgreymatterstructures.

★Spinalcord脊髓MRIlesion:Ahyperintenselesioninthecervical颈的,thoracic胸的,orlumbar腰的spinalcordseenonT2/STIR,orintwoplanesonT2images.

ImagingfindingsmoreinkeepingwithMS

Brain

?Lesionswithorientationperpendiculartoalateralventricle(Dawsonfingers(In,Dr.JamesWalkerDawsonnoticedapatternofplaquesinthebrainsofpeoplewithMS.Now,theseso-calledlesionsthatdoctorscallDawson’sfingersareatypicalsignofMS.))

?Lesionsadjacenttothetemporalhorns(lateralventricle)

?JuxtacorticallesionsinvolvingsubcorticalU-fibers

?Corticallesions

?Involvementofinferiorcorpuscallosum(callososeptalinterface)

Spinalcord

?Shortlesions3