Analysis of clinical and imaging characteristics of NMOSDs patients based on the 2015 version of diagnostic criteria

Abstract

Objective To analyze the clinical and imaging features of serum NMO-IgG-positive and NMO-IgG-negative Chinese patients with neuromyelitis optica spectrum disorders (NMOSDs) based on the 2015 version of diagnostic criteria.  Methods Retrospective analyses of clinical and imaging data were held on 96 patients with NMOSDs (64 NMO-IgG-positive patients and 32 NMO-IgG-negative patients) who were admitted to Tangdu Hospital of the Fourth Military Medical University from January 2013 to December 2015.  Results Gender ratio, age, age of onset, duration and annual relapse rate between NMO-IgG-positive and NMO-IgG-negative patients were of no significant difference. Symptoms of spinal cord involvement were most common during the first attack, with incidence rate of 48.44% (31/64) and 56.25% (18/32), respectively, for NMO-IgG-positive and NMO-IgG-negative patients, while limb numbness was most frequent. Among the first-episode optic nerve symptoms, unilateral visual loss was more common in NMO-IgG-positive patients (12/16) and bilateral visual loss was more frequent in NMO-IgG-negative patients (6/9). Intractable hiccups and vomiting suggestive of area postrema involvement was more common in NMO-IgG-positive group than that in NMO-IgG-negative group (11/18 vs 2/7), but the difference between 2 groups was not significant (P = 0.087, 0.202). The first-episode lesions of spinal cord were most frequently located in the cervical cord in both groups [41.67% (15/36) vs 11/17]. The incidence rates of both cervicothoracic cord lesions [41.67% (15/36) vs 1/17] and spinal cord lesions ≥ 7 vertebral segments [36.11% (13/36) vs 1/17] were significantly higher in NMO-IgG-positive group than those in NMO-IgG-negative group (P = 0.008, 0.022). The occurrence rates of intracranial lesions [90.63% (29/32) vs 14/17] and contiguous lesions involving medulla and cervical cord (6/11 vs 1/2) between 2 groups had no significant difference (P = 0.702, 1.000). During the disease course, there were no significant differences in the incidence of spinal cord [84.38% (54/64) vs 84.38% (27/32)], contiguous lesions involving medulla and cervical cord (9/19 vs 3/6) and intracranial lesions [86.54% (45/52) vs 83.33% (25/30)] between 2 groups (P = 1.000, 1.000, 0.934).  Conclusions Analysis of clinical and imaging features between NMO-IgG-positive and NMO-IgG-negative Chinese patients with NMOSDs according to the 2015 version of diagnostic criteria is helpful to further improve diagnostic level of the disease.

DOI: 10.3969/j.issn.1672-6731.2016.09.007