The presence of centrally located transverse myelitis (CLTM) on magnetic resonance imaging (MRI) may be helpful in the differentiation of neuromyelitis optica spectrum disorder (NMOSD) from multiple sclerosis (MS).

The presence of CLTM on MRI scans had a higher sensitivity and specificity (95.65% and 69.56%, respectively) for NMOSD diagnosis than the presence of long-extending transverse myelitis (LETM; sensitivity, 78.26%; specificity, 43.47%), according to a recent study published in Multiple Sclerosis and Related Disorders.

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The presence of LETM is one of the requirements when making an NMOSD diagnosis; however, it is not present in all NMOSD patients and can be found in some MS patients.

“Seronegative [neuromyelitis optica] patients do not usually present CLTM lesions, LETM may be present in MS patients, and [short transverse myelitis] may be present in NMOSD patients. Therefore, we suggest NMOSD diagnostic criteria also include the centrality, location, and expansion of the lesions, in addition to the presence of LETM in order for a more accurate distinction between NMOSD and its differential diagnosis,” the authors advised.

Included in the study were data from 17 MS patients, 23 NMOSD patients, and 6 myelin oligodendrocyte glycoprotein antibody disease (MOG-AD) patients. Imaging data revealed that 7 MS (41.4%), 18 NMOSD (78.26%), and all 6 MOG-AD patients had LETM lesions on their first cervical MRI. In contrast, 1 MS (5.8%), 22 NMOSD (95.65%), and all 6 MOG-AD patients had the presence of CLTM lesions on their scans. 

The presence of low-expansion and gadolinium-enhanced lesions were higher in patients with MS than in those with NMOSD (100% vs 8.69% and 52.94% vs 4.34%, respectively). Conversely, intermediate-expansion, high-expansion, and bright spotty lesions were more common in patients with NMOSD than in those with MS (43.47% vs 0%, 47.82% vs 0%, and 56.52% vs 5.88%, respectively).

Of the patients included in the study, women were disproportionately represented in each disease group, with 91.3% of NMOSD patients being female compared to 58.8% of MS patients and 66.67% of MOG-AD patients (P =.0231). The mean ages of each group (NMOSD, 34.08 years; MOG-AD, 30.83 years; MS, 32.29 years), however, were not statistically different (P =.293).

Reference

Etemadifar M, Salari M, Etemadifar MR, Sabeti F, Fateh ST, Aminzade Z. Centrally-located transverse myelitis would facilitate the differentiation of NMOSD and MOG-AD from MS. Mult Scler Relat Disord. Published online February 12, 2022. doi:10.1016/j.msard.2022.103664