3.0T Head And Spinal Cord MRI Research In The Diagnosis Of Neuromyelitis Optica Spectrum Disorders

Objective:We studied the application of 3.0T head and spinal cord MRI research in the diagnosis of neuromyelitis optica spectrum disorders(NMOSD),and explore the lesion distribution characteristics by magnetic resonance imaging(MRI).The patients were grouped according to according to aquaporin 4-IgG(AQP4-IgG)and Myelin-oligodendrocyte glycoprotein IgG(MOG-IgG)seropositive and seronegative.The MRI imaging features of the lesions were compared and analyzed,and the SPM and LST software was used for further analysis,including the difference of the number and volume of intracranial lesions among NMOSD patients.Methods:We conducted a retrospective analysis on 55 patients in the first bethune hospital of jilin university in September 2015 to March 2018,which according with International consensus diagnostic criteria for neuromyelitis optica spectrum disorders in 2015.All patients were scanned with Philips Ingenia 3.0T magnetic resonance scanning equipment.3DT1 WI,3DFLAIR and conventional axis T2 WI sequences were scanned on the head,and the 3DFLAIR sequence was processed and measured by SPM and LST software.The 3DT1 WI sequence was enhanced.The sagittal T1 WI,T2WI and axial T2 WI sequences were scanned on the spinal cord,sagittal T1 WI sequence was enhanced.The general clinical data,serum AQP4-IgG and MOG-IgG test results,MRI distribution characteristics were analyzed and recorded by Excel.Results:1.Among the 55 patients,12 were males and 43 were females.The ratio of male to female was 1:3.58.NMOSD can occur at all ages,ranging from 16 to 69 years old,with an average age of 44.96±13.59 years old,with a peak between 50 and 55 years old.The shortest course of disease was 3 days,the longest was 16 years,and the median course was 3.2 years.30 patients in this group were in the attack stage,most of them were in winter.2.The cerebral visible abnormalities demyelinating lesions was 94.5%(52/55),Most of the lesions have small lesions,which are scattered in spots and patches,and a few are white matter fusion lesions with large volume and diffuse cloud.Main distribution: the incidence of cerebellar lesions was 13.5%(7/52);the incidence of dorsal medulla lesions was 26.9%(14/52);the incidence of dorsal brainstem lesions adjacent to the fourth ventricle was 7.7%(4/52);the incidence of diencephalic lesions surrounding the third ventricles and cerebral aqueduct was 19.2%(10/52).the incidence of periependymal lesions surrounding the lateral ventricles was 61.5%(32/52).the incidence of hemispheric white matter lesions was 28.8%(15/52);the incidence of lesions involving corticospinal tracts was 5.8%(3/52);the incidence of globus pallidus was 9.6%(5/52);the incidence of nonspecific lesions was 90.4%(47/52).3.The optic nerve abnormalities patients was 38.2%(21/55),the incidence of unilateral optic nerve was 52.4%(11/21),the incidence of bilateral optic nerve was 47.6%(10/21),and 14.3%(3/21)involved optic chiasm.The 21 patients has 31 optic nerve abnormalities,16.1%(5/31)was less than 1/2 the optic nerve length,83.9%(26/31)was more than 1/2 the optic nerve length,16.1%(5/31)involved the posterior half of the optic nerve,and 83.9%(26/31)involved the entire optic nerve.4.spinal cord demyelinating lesions was 94.5%(41/55),focal segmental number were 251 segments,range 1 to 19,6.12±4.44 on average,78.0%(32/41)lesions were ≥ 3 vertebral segments,32.0%(23/41)lesions were < 3 vertebral segments.Among the 41 patients,cervical cord involvement patients number was 23,thoracic cord involvement patients number was 32,lumbar cord involvement patients number was 1.Simple involvement of cervical cord was 38.9%(8/41),simple involvement of thoracic cord was 20%(20/41),cervical cord lesions extension with medulla oblongata was 9.8%(4/41),both cervical cord and thoracic cord was 34.7%(11/41),both thoracic cord and lumbar cord was 2.8%(1/41).Spinal cord lesions are mostly located in the center of the spinal cord,followed by peripheral spinal cord,central and peripheral lesions of the spinal cord,extensive transverse lesions.5.Group according to serological indicators:(1)Group according to AQP4-Ig G seropositive and seronegative: 11 cases in the negative group and 39 cases in the positive group.Compared with AQP4-Ig G negative group,the incidence of dorsal medullary lesions in AQP4-IgG positive patients was low.(2)Group according to MOG-IgG seropositive and seronegative: there were 22 cases in the MOG-IgG negative group and 22 cases in the MOG-IgG positive group.Compared with the MOG-IgG negative group,the incidence of thalamus and optic nerve lesions in the MOG-IgG positive group was low.(3)According to AQP4-IgG single positive,MOG-IgG single positive,double positive and double negative : there were 19 cases in the AQP4-IgG single positive group,5 cases in the MOG-IgG single positive group,17 cases in double positive group and 3 cases in double negative group.Compared with other groups,the incidence of cerebellar lesions was high in double negative group.Compared with other groups,the incidence of dorsal medullary in the AQP4-IgG single positive group was high.6.The relationship between the number、volume of brain lesions and the serology of AQP4-IgG and MOG-IgG:(1)there was no statistically significant difference in the number and volume of lesions between AQP4-IgG seropositive and seronegative group.(2)there was no statistically significant difference in the number and volume of lesions between MOG-IgG seropositive and seronegative group.(3)there was no statistically significant difference in the number and volume of lesions among the four groups.Conclusion:1.3.0T head and spinal cord MRI research in the diagnosis of neuro myelitis optica spectrum disorders can provide a reliable basis for the diagnosis of this disease.2.Compared with AQP4-IgG negative group,the incidence of dorsal medullary lesions in AQP4-IgG positive patients was low.3.Compared with the MOG-IgG negative group,the incidence of thalamus lesions and optic nerve lesions in the MOG-IgG positive group was low.4.Compared with other groups,the incidence of cerebellar lesions in the double negative was high,and the incidence of dorsal medullary lesions in the AQP4-IgG single positive was high.