The Analysis On Clinical And Neuroimaging Features Of Neuromyelitis Optica Spectrum Disease

Objective To analye the clinical and central nervous system MRI features of neuromyelitis optica spectrum diseae.To analye MRI findings between groups of serum AQP4-Ab positive and negative/undetected.Method In this retrospective study,40 patients who were diagnosed NMOSD and 30 patients who were diagnosed MS in Hospital Affiliated to Institute of Neurology,Anhui University of Chinese Medicine.Cases were recruited since December,2012 to December,2017.All patients were performed brain and spinal MRI during hospitalization.TPO-Ab,TG-Ab,ANA,anti-SSA/anti-SSB,anti-Sm antibody and other serum autoantibody parameters were estimated among these 15 NMOSD and 11 MS patients.VEP,SEP and BAEP were performed on 23 cases with NMOSD and 13 cases with MS.We checked AQP4-Ab of 41 patients' serum(fixed-CBA),in which there had 20 cases with NMOSD positive,3 cases with NMOSD negative,17 cases with NMOSD unknown,18 cases with MS negative and 12 cases with MS unknown.Evaluated the difference of clinical manifestations,brain and spinal cord MRI features,merge the antibodies and evoked potential between groups of NMOSD and MS.Compared the difference of brain and spinal cord MRI performance between groups of serum AQP4-Ab positive NMOSD patients and negative or unknown NMOSD patients.Result1.The comparison of average onset age between groups of MS and NMOSD did not have statistical difference(P>0.05).The proportion of female patients in NMOSD group was more than which in MS group,and the difference was statistically significant(P<0.05).2.The starting symptoms and clinical manifestations performed as vision loss,limb paralysis and weakness in groups of NMOSD and MS.The manifestations of patients from two groups had plenty of overlaps.3.TPO-Ab,TG-Ab,ANA,anti-SSA/anti-SSB,anti-Sm antibody and other serum autoantibodies of 15 cases with NMOSD and 11 cases with MS had been checked.Patients in NMOSD group were more likely to be merged TPO-Ab,TG-Ab and ANA antibody positive than MS(P<0.05).There were no statistically significant difference between two groups of patients with SSA/SSB and SM antibody positive combined.4.No significant difference had been found in abnormal VEP,SEP and BAEP examination between groups of NMOSD and MS(P>0.05).5.All patients were performed brain MRI examination.No significant difference were found in the appearance rate of cerebral lesions and lesions of lateral ventricle surrounding,thalamus,brain stem,corpus callosum,lobe brain white matters,basal ganglia region between groups of NMOSD and MS(P>0.05).In cortical,subcortical and cerebellar lesions appearance rate,among patients with MS group were more common in NMOSD group(P<0.05).Medulla oblongata dorsal bright spots sign and line-like lesions along the ependymal distribution in T2 WI were more common among NMOSD patients than MS(P<0.05).NMOSD patients,in spite of group with serum AQP4-Ab positive or negative and undetected,rate of cerebral lesions appearance and lesions characteristics had no significant difference.6.All patients were performed spinal MRI examination.Spinal cord involvement were more likely to appear among NMOSD patients,and its length were significantly longer compare to MS patients(P<0.05).The involvements of cervical spinal cord and the junctional region of cervical and thoracic cord were more likely to appear among NMOSD patients(p<0.05),while no significant difference were found in the impairment of other spinal cord segments between groups of NMOSD and MS.On the characteristic of spinal cord lesions,NMOSD group of patients are more likely to appear line-like sign,LESCL,centric damage(P<0.05).Other characteristics of spinal cord lesions,such as BSLs,transverse damage,there has no statistically significant differences between the two groups(P>0.05).NMOSD patients,the serum levels of AQP4-Ab negative or undetected group appear more thoracic spinal cord segmental involvement accordingly,residual spinal cord lesion characteristics in patients of AQP4-Ab positive and negative or undetected group has no statistically significant difference(P>0.05).Conclusion1.ANA antibody,TPO-Ab,Tg-Ab and other autoimmune antibody are more likely to be detected from NMOSD patients rather than MS patients.2.Central nervous system MRI manifestations of NMOSD has relative specificity.Cortical,subcortical and cerebellar lesions may be the characteristic manifestations of MS which differ from NMOSD.Patients of NMOSD less frequent with vertical side of the lateral ventricle ovoid lesions,but the line-like lesion along the ependymal distribution and the medulla oblongata dorsal bright spots sign may be its characteristic brain MRI manifestations.In the spinal MRI performance,sections of spinal cord involvement in NMOSD patients are longer.Compared with MS,NMOSD patients are more likely to appear cervical spinal and cervical spinal extend thoracic cord involvement.Line-like lesions,LESCL and centricity damage may be characteristic spinal MRI manifestations of NMOSD.