MRI from a consecutive cohort of 84 subjects (NMOSD = 47, multiple sclerosis [MS] = 37) with AQP4 antibodies in serum and CSF were analyzed retrospectively.
The brain was normal in five of the 47 patients with NMOSD and none of the MS patients showed a normal brain. Twelve patients in each group had parenchymal enhancing lesions. Of these, white matter enhancement was more frequently found in MS patients than in NMOSD patients (12/12 vs 4/12, p = 0.001). 鈥淐loud-like鈥?enhancement was found in three NMOSD patients (3/12) and in one MS patient. Nine of the 12 NMOSD patients showed 鈥減encil-thin鈥?ependymal enhancement, whereas one of the 12 MS patients showed ependymal enhancement (p = 0.003). Enhancement along the lateral ventricle was more frequently found in NMOSD patients than in MS patients (p = 0.027), whereas enhancing lesions around the fourth ventricle tended to be more frequent in NMOSD patients than MS patients (p = 0.097). Leptomeningeal enhancement around the brainstem was found in six (12.8%) NMOSD patients and in no MS patients (p = 0.032).
Enhancement of the leptomeninges and ventricular ependymal region more frequently occurs in NMOSD patients than in MS patients. This may be considered as characteristic clue in the diagnosis of NMOSD.