Comparative Brain Stem Lesions on MRI of Acute Disseminated Encephalomyelitis, Neuromyelitis Optica, and Multiple Sclerosis
and Multiple Sclerosis. PLoS ONE 6(8): e22766. doi:10.1371/journal.pone.0022766
Comparative Brain Stem Lesions on MRI of Acute Disseminated Encephalomyelitis, Neuromyelitis Optica, and Multiple Sclerosis
Zhengqi Lu 0
Bingjun Zhang 0
Wei Qiu 0
Zhuang Kang 0
Liping Shen 0
Youming Long 0
Junqi Huang 0
Xueqiang Hu 0
Pablo Villoslada, Institute Biomedical Research August Pi Sunyer (IDIBAPS) - Hospital Clinic of Barcelona, Spain
0 1 Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China , 2 Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China , 3 Key Laboratory of Tropical Diseases Control, Ministry of Education and Department of Immunology/Institute of Immunology, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
Background: Brain stem lesions are common in patients with acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and multiple sclerosis (MS). Objectives: To investigate comparative brain stem lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, NMO, and MS. Methods: Sixty-five adult patients with ADEM (n = 17), NMO (n = 23), and MS (n = 25) who had brain stem lesions on MRI were enrolled. Morphological features of brain stem lesions among these diseases were assessed. Results: Patients with ADEM had a higher frequency of midbrain lesions than did patients with NMO (94.1% vs. 17.4%, P,0.001) and MS (94.1% vs. 40.0%, P,0.001); patients with NMO had a lower frequency of pons lesions than did patients with MS (34.8% vs. 84.0%, P,0.001) and ADEM (34.8% vs. 70.6%, P = 0.025); and patients with NMO had a higher frequency of medulla oblongata lesions than did patients with ADEM (91.3% vs. 35.3%, P,0.001) and MS (91.3% vs. 36.0%, P,0.001). On the axial section of the brain stem, the majority (82.4%) of patients with ADEM showed lesions on the ventral part; the brain stem lesions in patients with NMO were typically located in the dorsal part (91.3%); and lesions in patients with MS were found in both the ventral (44.0%) and dorsal (56.0%) parts. The lesions in patients with ADEM (100%) and NMO (91.3%) had poorly defined margins, while lesions of patients with MS (76.0%) had well defined margins. Brain stem lesions in patients with ADEM were usually bilateral and symmetrical (82.4%), while lesions in patients with NMO (87.0%) and MS (92.0%) were asymmetrical or unilateral. Conclusions: Brain stem lesions showed various morphological features among adult patients with ADEM, NMO, and MS. The different lesion locations may be helpful in distinguishing these diseases.
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Competing Interests: The authors have declared that no competing interests exist.
. These authors contributed equally to this work.
Idiopathic inflammatory demyelinating diseases (IIDDs) represent
a broad spectrum of central nervous system disorders that cannot be
completely differentiated on the basis of clinical course, lesion
distribution on imaging, and laboratory findings [14]. This spectrum
mainly includes multiple sclerosis (MS), neuromyelitis optica (NMO),
and acute disseminated encephalomyelitis (ADEM). ADEM is
typically known as a monophasic inflammatory demyelinating
disorder with polyfocal and aggressive neurological deficits; it usually
follows a viral infection or immunization [57]. NMO is an
inflammatory demyelinating disease characterized by a severe acute
transverse myelitis with bilateral simultaneous or sequential optic
neuropathy; it results in paraplegia and blindness with or without
recovery [810]. NMO is frequently reported in the Asian population,
including the Chinese [9]. MS occurs in young adults with Caucasian
predilection and is clinically characterized by episodes of focal
disorders of the optic nerves, brain, and spinal cord; it results in
characteristic complexes of symptoms and signs [11,12].
Numerous studies have reported that magnetic resonance
imaging (MRI) of patients with ADEM, NMO, and MS can show
cerebrum, brain stem, cerebellum, and spinal cord lesions.
Although MRI is one of the most important diagnostic criteria
that help to differentiate these diseases, there is no single MRI
feature that distinguishes ADEM from NMO, MS, and
cerebrovascular disease [13].
Brain stem lesions on MRI were reported in 37.5% to 65.0% of
patients with ADEM [5,1417], 23.0% to 44.8% of patients with
NMO [9,18,19], and 29.0% to 58.0% of patients with MS
[5,17,2022]. However, few systemic studies have focused on
brain stem lesions on MRI, especially in adult patients. Therefore,
this study investigated and compared brain stem lesions on MRI in
adult Chinese patients with ADEM, NMO, and MS.
Ethics Statement
This research was approved by the ethics committee of the
Third Affiliated Hospital of Sun Yat-sen University (No. 2007-33).
All participants involved in this study provided written informed
consent.
Patients
Our database comprised 282 patients with demyelinating
d (...truncated)