PT -期刊文章盟Cortese罗莎AU -卡拉斯科普拉多,弗兰AU -病重,卡门AU -比安奇,Alessia AU - Brownlee,华莱士AU -旧金山,Floriana AU - De La巴斯,伊莎贝尔盟——Grussu Francesco AU -海德尔,卢卡斯AU -雅各布,阿奴AU - Kanber,巴里斯AU - Magnollay,丽丝AU -尼古拉斯,理查德·s . AU -旅行,Anand盟——Yiannakas腻过盟——Toosy艾哈迈德·t . AU - Hacohen雅艾尔非盟- Barkhof弗雷德里克盟——CiccarelliOlga TI -影像辅助鉴别多发性硬化症与aqp4 -视神经脊髓炎谱系障碍和mog抗体疾病- 10.1212/WNL.0000000000201465DP - 2023 1月17日TA -神经学半岛投注体育官网PG - e308- e323 VI - 100 IP - 3 4099 - //www.ebmtp.com/content/100/3/e308.short 4100 - //www.ebmtp.com/content/100/3/e308.full SO -神经学2023 1月17日;背景和目的复发缓解型多发性硬化症(RRMS)、水通道蛋白-4抗体阳性的视神经脊髓炎谱系障碍(AQP4-NMOSD)和髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)可能具有重叠的临床特征。当血清学测试不可用或不明确时，对区分它们的成像标记物的需求没有得到满足。我们评估了MS典型的影像学特征是否能将RRMS与AQP4-NMOSD和MOGAD单独或联合区分开来。方法2014年至2019年间，在英国国立神经病学和神经外科医院(伦敦，英国)和沃尔顿中心(利物浦，英国)前瞻性招募了患有RRMS、APQ4-NMOSD和MOGAD的成年、非急性患者和健康对照组。半岛投注体育官网他们接受了常规和先进的脑、脊髓和视神经MRI和光学相干断层扫描(OCT)。结果共招募了91例连续患者(31例RRMS, 30例APQ4-NMOSD和30例MOGAD)和34例健康对照。区分RRMS与AQP4-NMOSD最准确的方法是具有中央静脉体征(CVS)的病变比例(84% vs 33%，准确性/特异性/敏感性:91/88/93%，p < 0.001), followed by cortical lesions (median: 2 [range: 1–14] vs 1 [0–1], accuracy/specificity/sensitivity: 84/90/77%, p = 0.002) and white matter lesions (mean: 39.07 [±25.8] vs 9.5 [±14], accuracy/specificity/sensitivity: 78/84/73%, p = 0.001). The combination of higher proportion of CVS, cortical lesions, and optic nerve magnetization transfer ratio reached the highest accuracy in distinguishing RRMS from AQP4-NMOSD (accuracy/specificity/sensitivity: 95/92/97%, p < 0.001). The most accurate measures favoring RRMS over MOGAD were white matter lesions (39.07 [±25.8] vs 1 [±2.3], accuracy/specificity/sensitivity: 94/94/93%, p = 0.006), followed by cortical lesions (2 [1–14] vs 1 [0–1], accuracy/specificity/sensitivity: 84/97/71%, p = 0.004), and retinal nerve fiber layer thickness (RNFL) (mean: 87.54 [±13.83] vs 75.54 [±20.33], accuracy/specificity/sensitivity: 80/79/81%, p = 0.009). Higher cortical lesion number combined with higher RNFL thickness best differentiated RRMS from MOGAD (accuracy/specificity/sensitivity: 84/92/77%, p < 0.001).Discussion Cortical lesions, CVS, and optic nerve markers achieve a high accuracy in distinguishing RRMS from APQ4-NMOSD and MOGAD. This information may be useful in clinical practice, especially outside the acute phase and when serologic testing is ambiguous or not promptly available.Classification of Evidence This study provides Class II evidence that selected conventional and advanced brain, cord, and optic nerve MRI and OCT markers distinguish adult patients with RRMS from AQP4-NMOSD and MOGAD.9-HPT=9-hole peg test; Ab=antibody; AQP4-NMOSD=aquaporin-4 antibody–positive neuromyelitis optica spectrum disorder; AUC=area under the curve; CBA=cell-based assay; CSA=cross-sectional area; CVS=central vein sign; DTI=diffusion tensor imaging; EDSS=Expanded Disability Status Scale; GCIPL=ganglion cell–inner plexiform layer; MOGAD=myelin oligodendrocyte glycoprotein antibody–associated disease; MTR=magnetization transfer ratio; OCT=optical coherence tomography; RC=regression coefficient; RRMS=relapsing-remitting multiple sclerosis; SWI=susceptibility-weighted imaging; TWT=timed 25-foot walk test