Comparison Of Brain And Spinal Cord Magnetic Resonance Imaging Features In Neuromyeitis Optica Patients With Or Without Aquaporin-4 Antibody

Background:neuromyelitis optica(NMO),also called Devic's disease or Devic syndrome,is an acute or subacute demyelinating lesion of the optic nerve and spinal cord that is or successively involved.The disease was previously recognized as a special type of multiple sclerosis(MS),and Neuromyelitis optica is a single phase syndrome with no involvement of other parts.Since 2004,with the discovery of antibodies against aquaporin 4(AQP4),it is rediscovered that NMO is different from MS in pathogenesis,pathological characteristics,clinical symptoms,laboratory tests,imaging findings,course of disease,prognosis and treatment.It is an inflammatory demyelinating disease of the central nervous system that is independent of MS.In particular,with the development of modern imaging technology,we have become more and more deeply aware of the imaging manifestations of optic neuromyelitis Imaging technology,especially nuclear magnetic resonance,has become an essential tool for our diagnosis of NMO.After observation,we found that the lesion of NMO is not confined to the spinal cord and optic nerve,and there are multiple lesions in the brain,but the characteristics of the lesions are different from those of MS patients The spinal cord and brain measurements are rarely investigated in NMO patients with and without antibodies to AQP4,directly compared to MS patientsObjective:To investigate magnetic resonance imaging(MRI)features of both brain and spinal cord in NMOSD patients with and without antibodies to AQP4,compared with MS patients and healthy controls(HC).Methods:We recruited 55 NMOSD patients including 30 AQP4(+)and 25 AQP4(-),25 MS and 25 HC.Brain and spinal cord MRIs were obtained for each participant.Brain lesions(BL),whole brain and deep grey matter volumes(DGMV),white matter diffusion metrics and spinal cord lesions were measured and compared among groups.At the same time,we detected the MOG antibodies of NMO patients in AQP4 negative group.4 of them were positive.We summarized the clinical data of MOG positive patients,and compared the image parameters between MOG positive and negative patients.Results:The incidence of BL was lower in the AQP4(+)group than in the AQP4(-)and MS groups(p<0.05).In the AQP4(+)group,there was a lower incidence of infratentorial lesions(ITL)and higher spinal cord lesions length than in the MS group(p<0.05).The whole brain volume of MS group was significantly smaller than that of normal control group(p<0.05),but there was no significant change in AQP4 antibody positive group and AQP4 antibody negative group.The volume of white matter in MS group was significantly smaller than that in normal control group(p<0.05),and the volume of white matter in MS group was also smaller than that in AQP4 antibody positive group(p<0.05).The thalamic and hippocampal volumes were smaller in the AQP4(-)group and MS group than in the HC group(p<0.05).As for indicators reflecting the integrity of white matter fibers,The MD value of group MS was different from that of normal control group(p<0.05).There was no statistical difference between the other parameters.There were no significant differences in the incidence of intracranial lesions,the incidence of subtentorial lesions,the number of spinal cord lesions,the length of spinal cord lesions,the volume of the whole brain,the volume of gray matter,the volume of white matter,and the volume of deep gray matter nucleus between the MOG antibody positive and negative groupsConclusions:The NMO patients with AQP4(-)showed higer prevalence of BL,ITL,and similar spinal cord lesion length,compared to AQP4(+),and demonstrated deep grey matter atrophy,and there was no difference in most of the indexes between the AQP4 negative patients and the MS patients.Suggesting an intermediate phenotype between that of typical MS and NMO.The effect of MOG antibody on the lesions of NMO patients needs more and larger sample studies.