Barnett Y, Sutton I J, Ghadiri M, Masters L, Zivadinov R, Barnett M H
From the Sydney Neuroimaging Analysis Centre (Y.B., M.H.B.), Sydney, AustraliaBrain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, AustraliaDepartment of Medical Imaging and Neurology (Y.B., I.J.S.), St Vincent's Hospital, Sydney, Australia.
Department of Medical Imaging and Neurology (Y.B., I.J.S.), St Vincent's Hospital, Sydney, Australia.
AJNR Am J Neuroradiol. 2014 Aug;35(8):1458-66. doi: 10.3174/ajnr.A3592. Epub 2013 Jun 13.
Myelitis and optic neuritis are prototypic clinical presentations of both multiple sclerosis and neuromyelitis optica. Once considered a subtype of multiple sclerosis, neuromyelitis optica, is now known to have a discrete pathogenesis in which antibodies to the water channel, aquaporin 4, play a critical role. Timely differentiation of neuromyelitis optica from MS is imperative, determining both prognosis and treatment strategy. Early, aggressive immunosuppression is required to prevent the accrual of severe disability in neuromyelitis optica; conversely, MS-specific therapies may exacerbate the disease. The diagnosis of neuromyelitis optica requires the integration of clinical, MR imaging, and laboratory data, but current criteria are insensitive and exclude patients with limited clinical syndromes. Failure to recognize the expanding spectrum of cerebral MR imaging patterns associated with aquaporin 4 antibody seropositivity adds to diagnostic uncertainty in some patients. We present the state of the art in conventional and nonconventional MR imaging in neuromyelitis optica and review the place of neuroimaging in the diagnosis, management, and research of the condition.
脊髓炎和视神经炎是多发性硬化症和视神经脊髓炎的典型临床表现。视神经脊髓炎曾被认为是多发性硬化症的一种亚型，现在已知其具有独特的发病机制，其中水通道蛋白4抗体起着关键作用。及时区分视神经脊髓炎和多发性硬化症至关重要，这决定了预后和治疗策略。在视神经脊髓炎中，需要早期积极的免疫抑制来预防严重残疾的累积；相反，针对多发性硬化症的疗法可能会使病情恶化。视神经脊髓炎的诊断需要综合临床、磁共振成像和实验室数据，但目前的标准不敏感，会排除临床综合征有限的患者。未能认识到与水通道蛋白4抗体血清阳性相关的脑磁共振成像模式范围不断扩大，增加了一些患者的诊断不确定性。我们介绍了视神经脊髓炎传统和非传统磁共振成像的最新情况，并回顾了神经影像学在该疾病的诊断、管理和研究中的地位。
