Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA.
J Neuroophthalmol. 2012 Sep;32(3):216-20. doi: 10.1097/WNO.0b013e318254c62d.
Patients with neuromyelitis optica (NMO) and multiple sclerosis (MS) both can present with acute optic neuritis (ON), while differing considerably in their prognosis and management. The clinical course, serologic testing results, and brain and spinal cord imaging of these diseases have been well documented. The purpose of this study was to look systematically for any differences in the imaging appearance of the optic nerve in NMO and MS-related ON.
Magnetic resonance imaging (MRI) of brain and orbits obtained within 6 weeks of acute ON in patients with securely diagnosed NMO (n = 6) and MS (n = 11) were retrospectively analyzed by a neuroradiologist masked to the clinical diagnosis. Standardized scoring system was used to assess and analyze the extent and nature of optic pathway involvement.
No significant differences were observed in the presence, degree, or the type of signal alteration and contrast enhancement of the affected nerve segments between NMO and MS groups. There was a trend toward more posterior involvement of the optic nerve in the NMO group with chiasmatic enhancement exclusively seen in NMO patients.
We found a higher propensity of NMO-related ON to affect more posterior parts of the optic nerve, including chiasm, and have simultaneous bilateral disease. Further study with larger sample sizes is needed.
视神经脊髓炎（NMO）和多发性硬化（MS）患者均可出现急性视神经炎（ON），但在预后和治疗方面存在显著差异。这些疾病的临床病程、血清学检测结果以及脑和脊髓的影像学表现均已有详细记载。本研究旨在系统地观察 NMO 和 MS 相关 ON 患者视神经影像学表现上的任何差异。
对经确诊的 NMO（n=6）和 MS（n=11）患者在急性 ON 后 6 周内获得的脑和眼眶磁共振成像（MRI）进行回顾性分析，由对临床诊断不知情的神经放射科医生进行。采用标准化评分系统评估和分析视神经通路受累的程度和性质。
在受累神经节段的信号改变和对比增强的存在、程度或类型方面，NMO 和 MS 组之间未观察到显著差异。NMO 组视神经的后段受累趋势更为明显，仅在 NMO 患者中可见视交叉增强。
我们发现 NMO 相关 ON 更倾向于累及视神经的后部区域，包括视交叉，且常为双侧同时受累。需要进一步进行更大样本量的研究。
