Advanced Neuroimaging Lab of The Multiple Sclerosis Centre of Veneto Region-First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Italy.
Neurology. 2012 Oct 16;79(16):1671-6. doi: 10.1212/WNL.0b013e31826e9a96. Epub 2012 Sep 19.
Neuromyelitis optica (NMO) is a severe inflammatory demyelinating disease of the CNS in which a pathogenic role of anti-aquaporin-4 (AQP4) antibodies has been suggested. Although AQP4 is expressed in human cortex, recent histologic studies have failed to find any evidence of cortical demyelination in NMO.
To evaluate, in vivo, the occurrence of focal and diffuse cortical pathology in NMO.
We studied 30 patients with NMO, 30 patients with relapsing-remitting multiple sclerosis (RRMS), and 30 normal controls (NC). RRMS and NC were age- and gender-matched to NMO. The presence of cortical lesions (CLs) was evaluated on double inversion recovery sequence and cortical thickness (CTh) by the application of Freesurfer on 3 volumetric fast field echo T1-weighted images.
No CL was observed in NC or in NMO, while 83 CLs were identified in 20/30 (66.7%) patients with RRMS. Although NMO did not differ from NC in the global CTh, a mild thinning was observed in some cortical areas (postcentral [p = 0.018], precentral [p = 0.009], and calcarine [p = 0.015] gyri) and in the thalamus (p = 0.036). Global and regional cortical thickness was significantly decreased in RRMS compared to both NMO and NC.
Our in vivo data further suggest that the immune-mediated pathologic process occurring in NMO spares most of the cortex. NMO differs from multiple sclerosis, where CLs and atrophy are frequently found, even in early disease phases. Thus, MRI analysis of the cortex may be a potential diagnostic tool, especially in ambiguous cases.
视神经脊髓炎（NMO）是一种严重的中枢神经系统炎症性脱髓鞘疾病，提示抗水通道蛋白 4（AQP4）抗体具有致病性作用。尽管 AQP4 表达于人类皮质，但最近的组织学研究并未发现 NMO 中有皮质脱髓鞘的任何证据。
在体内评估 NMO 中局灶性和弥漫性皮质病变的发生情况。
我们研究了 30 例 NMO 患者、30 例复发缓解型多发性硬化症（RRMS）患者和 30 名正常对照者（NC）。RRMS 和 NC 与 NMO 按年龄和性别匹配。通过对 3 个快速场回波 T1 加权容积图像应用 Freesurfer ，在双反转恢复序列和皮质厚度（CTh）上评估皮质病变（CL）的存在。
NC 或 NMO 中均未观察到 CL，而 RRMS 患者中有 20/30（66.7%）例存在 83 个 CL。尽管 NMO 在全球 CTh 上与 NC 无差异，但在一些皮质区域（中央后回[p=0.018]、中央前回[p=0.009]和舌回[p=0.015]）和丘脑（p=0.036）观察到轻微变薄。RRMS 的全球和区域皮质厚度明显低于 NMO 和 NC。
我们的体内数据进一步表明，发生在 NMO 中的免疫介导的病理过程使大多数皮质免受影响。NMO 与多发性硬化症不同，即使在早期疾病阶段，CL 和萎缩也经常发生。因此，皮质 MRI 分析可能是一种潜在的诊断工具，特别是在不明确的病例中。
