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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleSpine Imaging and Spine Image-Guided Interventions

MRI Features of Aquaporin-4 Antibody–Positive Longitudinally Extensive Transverse Myelitis: Insights into the Diagnosis of Neuromyelitis Optica Spectrum Disorders

C.G. Chee, K.S. Park, J.W. Lee, H.W. Ahn, E. Lee, Y. Kang and H.S. Kang
American Journal of Neuroradiology February 2018, DOI: https://doi.org/10.3174/ajnr.A5551
C.G. Chee
aFrom the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
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K.S. Park
bNeurology (K.S.P.), Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
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J.W. Lee
aFrom the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
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H.W. Ahn
aFrom the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
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E. Lee
aFrom the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
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Y. Kang
aFrom the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
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H.S. Kang
aFrom the Departments of Radiology (C.G.C., J.W.L., H.W.A., E.L., Y.K., H.S.K.)
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    Fig 1.

    Sagittal T2-weighted spinal MR imaging of a 36-year-old woman with LETM. The lesion extends beyond the imaginary line (dashed line) connecting the inferior cortex of the C1 anterior and posterior arches. Cervicomedullary junction involvement is present.

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    Fig 2.

    Sagittal T2-weighted spinal MR imaging of a 43-year-old man with LETM. Cord expansion ratio is measured as the anteroposterior diameter of the most swollen spinal cord segment (solid line) to the anteroposterior diameter of the noninvolved spinal cord in the cranial direction (dotted line). Two independent readers measured the cord expansion ratio as 1.65 and 1.71.

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    Fig 3.

    Two examples of bright spotty lesions (white arrows) in axial T2-weighted spinal MR imaging. Two independent readers judged the lesions as positive.

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    Table 1:

    Patient characteristics (n = 41)a

    CharacteristicAQP4 Antibody–Positive Group (n = 15)AQP4 Antibody–Negative Group (n = 26)
    Age (mean) (yr)48 ± 1342 ± 12
    Female13 (87%)5 (19%)
    EthnicityAsian (100%)Asian (100%)
    Time interval from first attack to MRI study (median) (interquartile range) (days)10 (3–21)14 (5–30)
        1–15 days10 (67%)14 (54%)
        16–30 days3 (20%)6 (23%)
        31–60 days1 (1%)2 (8%)
        >60 days1 (1%)4 (15%)
    Brain involvement8 (53%)10 (38%)
    Preceding optic neuritis4 (27%)1 (4%)
    • ↵a Data are number and percentage unless otherwise indicated.

    • View popup
    Table 2:

    Spinal MRI findings in AQP4 antibody–positive and –negative groupsa

    Imaging FeaturesAQP4 Antibody–Positive Group (n = 15)AQP4 Antibody–Negative Group (n = 26)
    Cervicomedullary junction involvement9 (60%)6 (23%)
        Medulla oblongata involvement4 (27%)1 (4%)
    Cord expansion ratio (mean) (onset ≤2 months)b1.35 ± 0.151.24 ± 0.15
    Cord expansion ratio (mean) (onset ≤15 days)c1.34 ± 0.171.24 ± 0.17
    Bright spotty lesion
        Negative1 (7%)18 (69%)
        Positive14 (93%)8 (31%)
    Involved segment
        Cervical5 (33%)7 (27%)
        Cervicothoracic8 (53%)5 (19%)
        Thoracic2 (13%)10 (38%)
        Thoracolumbar0 (0%)1 (4%)
        Holocord0 (0%)3 (12%)
    No. of segments involved (mean)9 ± 47 ± 4
    Axial distribution
        Central10 (67%)21 (81%)
        Peripheral4 (27%)4 (15%)
        Both1 (7%)1 (4%)
    >Half of the cord area12 (80%)24 (92%)
    Enhancement
        No enhancement4 (27%)6 (23%)
        <50% enhancement9 (60%)17 (65%)
        >50% enhancement0 (0%)0 (0%)
        Not available2 (13%)3 (12%)
    • ↵a Data are number and percentage unless otherwise indicated.

    • ↵b Cord expansion ratio was measured only for 32 patients.

    • ↵c Cord expansion ratio was measured only for 22 patients.

    • View popup
    Table 3:

    Univariable logistic regression analysis

    VariableOR (95% CI)P Value
    Sex
        MaleReference
        Female3.3 (1.5–5.1)<.001
    Cervicomedullary involvement
        AbsentReference
        Present1.6 (0.2–3.0).02
    Bright spotty lesion
        NegativeReference
        Positive3.4 (1.3–5.6).002
    Cord expansion ratio
        ≤1.4Reference
        >1.42.1 (0.5–3.7).01
    • View popup
    Table 4:

    Scoring system

    ParametersPoints
    Sex
        Male0
        Female1
    Cervicomedullary involvement
        Absent0
        Present1
    Medulla oblongata involvement+1 = 2
    Bright spotty lesion
        Absent or suspicious0
        Definite1
    Cord expansion ratio for acute or early-stage MRI
        ≤1.40
        >1.41
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MRI Features of Aquaporin-4 Antibody–Positive Longitudinally Extensive Transverse Myelitis: Insights into the Diagnosis of Neuromyelitis Optica Spectrum Disorders
C.G. Chee, K.S. Park, J.W. Lee, H.W. Ahn, E. Lee, Y. Kang, H.S. Kang
American Journal of Neuroradiology Feb 2018, DOI: 10.3174/ajnr.A5551
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C.G. Chee, K.S. Park, J.W. Lee, H.W. Ahn, E. Lee, Y. Kang, H.S. Kang
MRI Features of Aquaporin-4 Antibody–Positive Longitudinally Extensive Transverse Myelitis: Insights into the Diagnosis of Neuromyelitis Optica Spectrum Disorders
American Journal of Neuroradiology Feb 2018, DOI: 10.3174/ajnr.A5551

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