Imaging

Neuromyelitis Optica

Preliminary Diagnosis: Neuromyelitis Optica

I. What imaging technique is first-line for this diagnosis?

  • MR imaging of the orbits and spine

II. Describe the advantages and disadvantages of this technique for diagnosis of neuromyelitis optica.

Advantages

  • May be diagnostic with positive pertinent findings

  • Able to locate the level of demyelination and inflammation within the spine in addition to the optic nerves and is able to predict any neurological (sensory, motor, or autonomic) and specifically dermatomal abnormalities

  • Able to rule out any secondary complications from a primary demyelinating or inflammatory optic neuritis and transverse myelitis such as intracerebral abscess, discitis, osteomyelitis, or epidural abscesses

  • Does not make use of any ionizing radiation

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • MR imaging with intravenous contrast requires the patient have good renal function with GFR >60. Administration of intravenous contrast is decided on a case-by-case basis with GFR <60 and >30.

III. What are the contraindications for the first-line imaging technique?

  • Contraindicated in patients with non–MR-compatible metallic hardware or foreign bodies

IV. What alternative imaging techniques are available?

  • No alternative diagnostic imaging modalities are available.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of neuromyelitis optica.

  • Not applicable

VI. What are the contraindications for the alternative imaging techniques?

  • Not applicable

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