TY - JOUR T1 -用影像学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JF -神经学JO -神经学SP - e308 LP - e323 DO - 10.1212/WNL.0000000000201465首页六世- 100 - 3盟罗莎Cortese盟-弗兰普拉多卡拉斯科AU -卡门病重盟Alessia比安奇AU -华莱士Brownlee盟Floriana De旧金山盟——伊莎贝尔拉巴斯德盟Francesco Grussu AU -卢卡斯海德尔盟阿奴雅各盟-巴里斯Kanber AU -丽丝Magnollay AU -尼古拉斯(Richard s . AU - Anand旅行盟腻过Yiannakas AU -艾哈迈德·t·Toosy盟雅艾尔Hacohen盟——弗雷德里克Barkhof AU -奥尔加Ciccarelli Y1 2023/01/17 UR - //www.ez-admanager.com/content/100/3/e308.abstract N2 -背景和首页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。首页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 <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)。 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 ER -