Specific MRI findings help distinguish acute transverse myelitis of Neuromyelitis Optica from spinal cord infarction

Background: There is substantial overlap between MRI of acute spinal cord lesions from neuromyelitis optica (NMO) and spinal cord infarct (SCI) in clinical practice. However, early differentiation is important since management approaches to minimize morbidity from NMO or SCI differ significantly. Objective: To identify MRI features at initial presentation that may help to differentiate NMO acute myelitis from SCI. Methods: 2 board-certified neuroradiologists, blinded to final diagnosis, retrospectively characterized MRI features at symptom onset for subjects with serologically-proven NMO (N=13) or SCI (N=11) from a single institution. Univariate and multivariate analyses were used to identify factors associated with NMO or SCI. Results: SCI was more common in men and Caucasians, while NMO was more common in non-Caucasian women (P < 0.05). MRI features associated with NMO acute myelitis (P < 0.05) included location within 7-cm of cervicomedullary junction; lesion extending to pial surface; 'bright spotty lesions' on axial T2 MRI; and gadolinium enhancement. Patient's age, lesion length and cross-sectional area, cord expansion, and the "owl's eyes" sign did not differ between the two groups (P> 0.05). Conclusion: Along with patient demographic characteristics, lesion features on MRI, including lesion location, extension to pial border and presence of 'bright spotty lesion' can help differentiate acute myelitis of NMO from SCI in the acute setting. (C) 2016 Elsevier B.V. All rights reserved.