Multiple sclerosis (MS) shares similar clinical and imaging characteristics with neuromyelitis optica spectrum disorders (NMOSD), but a correct diagnosis is essential as treatment options differ considerably. We applied diffusion tensor imaging, neurite orientation dispersion and density imaging, and synthetic quantitative MRI to assess the gray matter (GM) of relapsing-remitting MS (RRMS) and NMOSD patients. Our results demonstrated that multimodal neuroimaging techniques of the GM might be useful for differentiating NMOSD from RRMS, where NMOSD spares most of the GM. In contrast, RRMS group demonstrated extensive demyelination, circumscribed axonal loss predominantly in the limbic areas, and broad neuroinflammation in the cerebellum.
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