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Magnetic resonance imaging in enterovirus‐71, myelin oligodendrocyte glycoprotein antibody, aquaporin‐4 antibody, and multiple sclerosis‐associated myelitis in children
Author(s) -
Tantsis Esther M,
Prelog Kristina,
Alper Gulay,
Benson Leslie,
Gorman Mark,
Lim Ming,
Mohammad Shekeeb S,
Ramanathan Sudarshini,
Brilot Fabienne,
Dale Russell C
Publication year - 2019
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14114
Subject(s) - transverse myelitis , multiple sclerosis , medicine , myelitis , neuromyelitis optica , spinal cord , magnetic resonance imaging , pathology , acute transverse myelitis , myelin oligodendrocyte glycoprotein , encephalomyelitis , neuroimaging , aquaporin 4 , white matter , hyperintensity , radiology , immunology , experimental autoimmune encephalomyelitis , psychiatry
Aim We used magnetic resonance imaging ( MRI ) to compare the neuroimaging of children with their first episode of clinical enterovirus 71‐associated transverse myelitis ( EV 71‐ TM ), myelin oligodendrocyte glycoprotein antibody positive transverse myelitis ( MOG ‐ TM ), aquaporin‐4 antibody positive transverse myelitis ( AQP 4‐ TM ), transverse myelitis in multiple sclerosis ( MS ‐ TM ), and unclassified transverse myelitis ( UNC ‐ TM ). Method We performed a retrospective blinded radiological assessment and compared the neuroimaging of 52 children (32 females, 20 males; mean age 9y 8mo, SD 5y 5mo, range 5mo–17y) presenting with their first episode of myelitis caused by EV 71‐ TM ( n =11), MOG ‐ TM ( n =10), AQP 4‐ TM ( n =9), MS ‐ TM ( n =13), and UNC ‐ TM ( n =9). Results In the EV 71‐ TM group, lesions were distributed throughout the cord and enhancement of nerve roots (ventral and dorsal) was common. The MOG ‐ TM group had lesions distributed throughout the cord and most commonly longitudinally extensive transverse myelitis and lesions involving the grey matter alone on axial scans. The AQP 4‐ TM group had lesions distributed in the cervicothoracic spine, cavitation, and contrast enhancing lesions. All patients with AQP 4‐ TM had an abnormal brain MRI scan. The MS ‐ TM group characteristically had multiple short segment lesions of the cord involving the cervicothoracic spine. The UNC ‐ TM group did not have distinctive spinal MRI findings but had a relative paucity of lesions on their brain MRI scans. Interpretation There are neuroimaging findings that are helpful in differentiating between myelitis associated with EV 71, MOG , AQP 4, and multiple sclerosis in children. These features may be useful early in the presentation of transverse myelitis while awaiting infectious/immunological testing, and/or further demyelinating events. What this paper adds Magnetic resonance imaging can help identify aetiologies for children presenting with a first episode of myelitis. Entervirus‐71‐associated myelitis lesions are distributed throughout the cord and enhancement of nerve roots is common. Lesions distributed throughout the cord are commonly seen in myelin oligodendrocyte‐associated myelitis. Aquaporin‐4‐associated myelitis lesions are distributed in the cervicothoracic spine, cavitation and contrast enhancing lesions are common. Short segment lesions in the cervicothoracic spine are commonly seen in multiple sclerosis‐associated myelitis.