summary: Neuromyelitis optica (NMO) and MS and are both inflammatory-demyelinating diseases of the central nervous system, with NMO mainly affecting the spinal cord and the optic nerve. It is not clear whether MS and NMO are different diseases or different versions of the same disease. Since both prognosis and treatment may be very different for the two diseases, the correct and early differentiation between them is of great importance in clinical practice. However, clinical and MRI data are not always sufficient for making this differentiation. With MS it is well known that typical brain lesions and damage in the brain tissue, which seems normal when studied by conventional MRI techniques play a role in the development of disability. Whilst the white matter of people with MS appears normal when examined with conventional MRI techniques, it shows abnormalities when non-conventional MRI techniques are used. With NMO it is not clear whether there is also significant and meaningful damage in brains that appear normal using conventional MRI techniques. The authors studied whether white matter in the brains of a group of people with NMO showed abnormalities using spectroscopic MRI, a new technique which can detect abnormalities in the chemical composition of the brain tissue. When the authors compared the spectroscopic MRI scans of people with NMO with a group of healthy controls no differences were found. These findings are very important because they suggest that the study of brain tissue that appears normal may be a tool to differentiate people with MS and with NMO in clinical practice, when conventional MRI and clinical data are insufficient.

authors: Aboul-Enein F, Krssák M, Höftberger R, Prayer D, Kristoferitsch W

source: AJNR Am J Neuroradiol. 2009 Sep 12

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