AQP4 阴性 NMOSD 与 MS 的磁敏感加权成像特征。
Susceptibility-weighted image features in AQP4-negative-NMOSD versus MS.
机构信息
Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, PR China.
Center for Neurology, Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China/China National Clinical Research Center for Neurological Diseases, Beijing, PR China.
出版信息
Mult Scler Relat Disord. 2024 Feb;82:105406. doi: 10.1016/j.msard.2023.105406. Epub 2023 Dec 28.
OBJECTIVE
To characterize the susceptibility-weighted image (SWI) features including paramagnetic rim and nodular lesions with signal intensity changes and central vein sign (CVS) associated with aquaporin 4 (AQP4)-immunoglobulin G (IgG)-negative neuromyelitis optica spectrum disorder (NMOSD), and explore whether they can be used as potential imaging biomarkers for differentiating multiple sclerosis (MS) from this disorder.
METHODS
We prospectively recruited NMOSD with AQP4-IgG-negative (AQP4- NMOSD) and IgG-positive (AQP4+ NMOSD), and MS subjects from the Clinical and Imaging Patterns of Neuroinflammation Diseases in China (CLUE) project (NCT0410683) between 2019 and 2021. The SWI features including paramagnetic rim and nodular lesions with signal intensity changes and CVS were analyzed and compared among groups, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for distinguishing MS from AQP4- NMOSD.
RESULTS
We enrolled a total of 160 consecutive patients (22 AQP4- NMOSD, 65 AQP4+ NMOSD, and 73 MS). We observed paramagnetic rim lesion (0/120 lesions, 0 %) and nodular (1/120, 1 %) lesions with hypointense signals on SWI in the AQP4- NMOSD group. These characteristics were similar to those recorded from AQP4+ NMOSD patients (rim: 0/369 lesions, 0 %, P = 1.000; nodular: 10/369 lesions, 2.7 %, P = 1.000), but differed significantly from those observed in the MS group (rim: 162/1665 lesions, 9.7 %, P<0.001; nodular: 392/1665 lesions, 23.5 %, P < 0.001). AQP4- NMOSD patients had fewer average CVS+ rate (12 %) than MS patients (46 %, p<0.001), similar to AQP4+ NMOSD (13 %, p = 1.000). The SWI imaging features denoting lesions with paramagnetic rim or nodular hypointense SWI signals showed 90.4 % sensitivity, 95.5 % specificity, 98.5 % PPV, and 75 % NPV, and the criteria with≥3 CVS lesions showed sensitivity of 91.8 %, specificity of 90.9 %%, PPV of 97.1 %, and NPV of 76.9 % in distinguishing MS from AQP4- NMOSD.
DISCUSSION
The SWI imaging features including lesions with paramagnetic rim or nodular hypointense SWI signals and 3 CVS lesions carries useful information in distinguishing MS from AQP4- NMOSD.
目的
描述与水通道蛋白 4（AQP4）-免疫球蛋白 G（IgG）阴性视神经脊髓炎谱系疾病（NMOSD）相关的磁敏感加权成像（SWI）特征，包括顺磁性边缘和结节状病变伴信号强度变化和中央静脉征（CVS），并探讨其是否可作为区分多发性硬化症（MS）与该病的潜在影像生物标志物。
方法
我们前瞻性地招募了来自中国神经炎症性疾病的临床和影像模式（CLUE）项目（NCT0410683）的 2019 年至 2021 年间 AQP4-IgG 阴性（AQP4-NMOSD）和 IgG 阳性（AQP4+ NMOSD）NMOSD 以及 MS 患者。分析并比较了各组的 SWI 特征，包括顺磁性边缘和结节状病变伴信号强度变化和 CVS，并确定了用于区分 MS 与 AQP4-NMOSD 的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
结果
我们共纳入了 160 例连续患者（22 例 AQP4-NMOSD、65 例 AQP4+ NMOSD 和 73 例 MS）。我们观察到 AQP4-NMOSD 组的 SWI 上有顺磁性边缘病变（0/120 个病变，0%）和结节状病变（1/120 个病变，1%）呈低信号。这些特征与 AQP4+ NMOSD 患者的记录相似（边缘：0/369 个病变，0%，P=1.000；结节：10/369 个病变，2.7%，P=1.000），但与 MS 组明显不同（边缘：162/1665 个病变，9.7%，P<0.001；结节：392/1665 个病变，23.5%，P<0.001）。AQP4-NMOSD 患者的平均 CVS+率（12%）低于 MS 患者（46%，p<0.001），与 AQP4+ NMOSD 患者相似（13%，p=1.000）。SWI 成像特征表示具有顺磁性边缘或结节状低信号 SWI 病变的特征具有 90.4%的敏感性、95.5%的特异性、98.5%的阳性预测值和 75%的阴性预测值，而具有≥3 个 CVS 病变的标准具有 91.8%的敏感性、90.9%的特异性、97.1%的阳性预测值和 76.9%的阴性预测值，用于区分 MS 与 AQP4-NMOSD。
讨论
SWI 成像特征包括具有顺磁性边缘或结节状低信号 SWI 病变和 3 个 CVS 病变的特征，可提供有助于区分 MS 与 AQP4-NMOSD 的信息。
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