Department of neurology, the Third Hospital of Hebei Medical University, Shijiazhuang, China.
Neurosurgery, the Third Hospital of Hebei Medical University, Shijiazhuang, China.
BMC Neurol. 2024 Oct 2;24(1):369. doi: 10.1186/s12883-024-03884-w.
The clinical symptoms of neuromyelitis optica spectrum disorder (NMOSD) and acute cervical spondylotic myelopathy (CSM) may overlap in some cases. This study aimed to investigate the differences in imaging features between NMOSD and CSM in acute myelopathy.
We included 78 patients in this retrospective study, including 28 NMOSD patients and 50 CSM patients. The demographic characteristics and clinical symptoms of the two groups of patients were compared. The T1 signal intensity, length of the spinal cord involved by T2 hyperintensity, degree of intervertebral disc degeneration, proportion of thoracic and lumbar cord involvement, proportion of brain involvement and lesion enhancement rate in magnetic resonance imaging (MRI) were compared between the two groups of patients. The number, length, location on the sagittal image, pattern on the sagittal image, and distribution on the axial image of the lesions in the contrast-enhanced MRI of the two groups were evaluated.
There were differences between NMOSD and CSM patients in the proportion of women, the proportion of bowel and bladder symptoms, mRS levels, the length of the spinal cord involved by T2 hyperintensity, degree of intervertebral disc degeneration, the proportion of thoracic and lumbar cord involvement, the proportion of brain involvement, the enhancement rate and number of lesions (p < 0.05). Among NMOSD patients, linear, patchy and ring or semi-ring enhancement were present in 8(30.8%) ,14 (53.8%) and 4(15.4%)patients, respectively, and axial gray and white matter were involved in 17 (65.4%) patients. Among patients with CSM, 9(36.0%) patients showed longitudinal oriented flake, 16 (64.0%) patients showed pancake-like enhancement, and 21 (84.0%) patients showed axial white matter involvement only. The differences in enhancement pattern on sagittal images and axial involvement were statistically significant (p < 0.05).
Early differential diagnosis of NMOSD and CSM in acute myelopathy can be made by analyzing images and the number, length, sagittal enhancement pattern, and axial involvement of gadolinium-enhanced lesions.
神经脊髓炎谱系疾病（NMOSD）和急性颈椎病性脊髓病（CSM）的临床症状在某些情况下可能重叠。本研究旨在探讨急性脊髓病中 NMOSD 和 CSM 影像学特征的差异。
我们回顾性纳入了 78 例患者，其中 28 例 NMOSD 患者和 50 例 CSM 患者。比较两组患者的人口统计学特征和临床症状。比较两组患者的磁共振成像（MRI）T1 信号强度、T2 高信号累及脊髓长度、椎间盘退变程度、胸腰椎受累比例、脑受累比例及病灶增强率。评估两组患者增强 MRI 上病灶的数量、长度、矢状位图像上的位置、矢状位图像上的模式及轴位图像上的分布。
NMOSD 和 CSM 患者在女性比例、肠膀胱症状比例、mRS 评分、T2 高信号累及脊髓长度、椎间盘退变程度、胸腰椎受累比例、脑受累比例、增强率及病灶数量方面存在差异（p < 0.05）。NMOSD 患者中，8 例（30.8%）患者表现为线状、斑片状及环形或半环形强化，14 例（53.8%）患者表现为弥漫性强化，4 例（15.4%）患者表现为多灶性强化；17 例（65.4%）患者累及轴位灰质和白质。CSM 患者中，9 例（36.0%）患者表现为纵向片状强化，16 例（64.0%）患者表现为饼状强化，21 例（84.0%）患者仅累及轴位白质。两组患者在矢状位图像增强模式及轴位受累方面存在差异，具有统计学意义（p < 0.05）。
通过分析图像、增强病灶的数量、长度、矢状位增强模式和轴位受累情况，可对急性脊髓病中 NMOSD 和 CSM 进行早期鉴别诊断。
