RT杂志文章SR电子T1鉴别多发性硬化症与aqp4 -神经脊髓炎视谱障碍和mog -抗体疾病的影像学JF神经病学JO神经病学FD Lippincott Williams & Wilkins SP e308 OP e323 DO 10.1212/WNL.0000000000201465半岛投注体育官网vo100 IS 3 A1 Cortese, Rosa A1 Prados卡拉斯科，Ferran A1 turr, Carmen A1 Bianchi, Alessia A1 Brownlee, Wallace A1 De Angelis, Floriana A1 De La Paz, Isabel A1 Grussu, Francesco A1 Haider, Lukas A1 Jacob, Anu A1 Kanber, Baris A1 Magnollay, Lise A1 Nicholas, Richard S. A1 Trip, Anand A1 Yiannakas, Marios A1 Toosy, Ahmed T. A1 Hacohen, Yael A1 Barkhof, Frederik A1 Ciccarelli，背景和目的复发缓解型多发性硬化症(RRMS)、水通半岛投注体育官网道蛋白-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%，准确度/特异性/敏感性:91/88/93%，p < 0.001)，其次是皮质病变(中位数:2[范围:1 - 14]vs 1[0-1]，准确度/特异性/敏感性:84/90/77%，p = 0.002)和白质病变(平均值:39.07[±25.8]vs 9.5[±14]，准确度/特异性/敏感性:78/84/73%，p = 0.001)。较高的CVS比例、皮质病变和视神经磁化转移比组合在区分RRMS与AQP4-NMOSD时达到最高的准确性(准确性/特异性/敏感性: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