Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Neurol Sci. 2011 Mar 15;302(1-2):43-8. doi: 10.1016/j.jns.2010.12.001. Epub 2011 Jan 13.
Differentiating neuromyelitis optica (NMO) from multiple sclerosis (MS) is a real challenge in the clinical field. In the past, NMO (not MS), was inferred when abnormality was not detected in the brain magnetic resonance imaging (MRI). Recently, some studies have reported abnormalities in the brain MRIs of NMO, but only few among the Asian population. The aim of this study was to evaluate the frequency of brain MRI among Korean NMO patients and characterize findings that might be helpful to distinguish NMO from MS.
Medical records, NMO-IgG, and brain MRI of 17 patients diagnosed with NMO by the revised diagnostic criteria of Wingerchuk et al. (2006) [6] from 2008 to 2010, were reviewed.
11 out of 17 patients (64.7%) had abnormal MRI findings. More than two lesions were detected in most patients. The majority of patients with brain MRI abnormality showed nonspecific (5 patients) or atypical (6 patients) findings. Cerebral white matter was most frequently involved (58.8%). 3 patients (17.6%) involved corpus callosum, 4 (23.5%) with internal capsule, 2 (11.8%) with cerebellum, and 3 (17.6%) with brainstem. There were 5 (29.4%) patients who met the Paty et al. criteria (1988) [15] and 3 patients (35.3%) who met the multiple sclerosis (MS) spatial distribution diagnostic criteria of Barkhof et al. (1997) [14] in their brain MRI.
Brain abnormalities have been frequently found among Korean NMO patients and the frequencies have been reported to be higher than that of Caucasians. Current MS spatial distribution criteria, such as Paty et al. (1988) [15] or Barkhof et al. (1997) [14], are not sufficient to discriminate NMO from MS in brain MRI findings. Our results will provide valuable information that would be useful in establishing future revising criteria for NMO.
在临床领域，区分视神经脊髓炎（NMO）和多发性硬化症（MS）是一个真正的挑战。过去，当脑部磁共振成像（MRI）检查未发现异常时，推断为 NMO（而非 MS）。最近，一些研究报告了 NMO 患者脑部 MRI 的异常，但在亚洲人群中只有少数报告。本研究的目的是评估韩国 NMO 患者的脑部 MRI 频率，并描述有助于区分 NMO 和 MS 的特征。
对 2008 年至 2010 年间，根据 Wingerchuk 等人修订的诊断标准（2006 年）[6]诊断为 NMO 的 17 例患者的病历、NMO-IgG 和脑部 MRI 进行了回顾性分析。
17 例患者中，11 例（64.7%）MRI 检查结果异常。大多数患者的病变超过 2 个。多数脑部 MRI 异常患者表现为非特异性（5 例）或非典型（6 例）病变。脑白质最常受累（58.8%）。3 例（17.6%）累及胼胝体，4 例（23.5%）累及内囊，2 例（11.8%）累及小脑，3 例（17.6%）累及脑干。5 例（29.4%）患者符合 Paty 等人的标准（1988 年）[15]，3 例（35.3%）符合 Barkhof 等人的多发性硬化症（MS）空间分布诊断标准（1997 年）[14]。
韩国 NMO 患者常出现脑部异常，其频率高于白种人。目前的 MS 空间分布标准，如 Paty 等人的标准（1988 年）[15]或 Barkhof 等人的标准（1997 年）[14]，在脑部 MRI 结果中不足以区分 NMO 和 MS。我们的结果将提供有价值的信息，有助于为 NMO 制定未来的修订标准。
