Radiological Markers Capable of Differentiating Multiple Sclerosis from Neuromyelitis Optica Spectrum Disorder; a Systematic Review and Meta-Analysis

• Published in: Multiple sclerosis and related disorders 2023-03, Vol.71, p.104323, Article 104323
• Main Authors: Bagherieh, Sara, Panah, Mohammad Yazdan, Mokary, Yousef, Shobeiri, Parnian, Mirmosayyeb, Omid
• Format: Article
• Language: English
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2022.104323

Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are two of the most vicious demyelinating diseases of the central nervous system (CNS), and distinguishing them at baseline by means of clinical characteristics can be challenging. Herein, we aimed to systematically review radiological indicators that can distinguish NMO patients from MS patients. MEDLINE, Scopus, EMBASE, and Web of Science databases were searched online till July 1, 2022, to retrieve relevant investigations. All the studies that reported any diagnostic test accuracy measure on radiological makers to differentiate MS from NMOSD, at baseline, were included. Meta-analyses were conducted on two sets of markers: a) lesions adjacent to the body of a lateral ventricle and in the inferior temporal lobe, and b) lesions adjacent to the body of a lateral ventricle accompanied by inferior temporal lobe lesions, u-fiber, and Dawson's finger type lesions (the combined criteria). Our meta-analysis on the diagnostic efficiency of lesions adjacent to the body of a lateral ventricle and in the inferior temporal lobe suggests this marker has a mean sensitivity, specificity, PPV, and NPV of 69.75% [95%CI: 58.35% - 78.86%], 96.10% [95% CI: 93.21% - 97.79%], 96.37% [95% CI: 93.54% – 97.98%], and 66.89% [95% CI: 60.92% – 72.36%], respectively. Moreover, the differentiating efficiency of lesions adjacent to the body of a lateral ventricle accompanied by inferior temporal lobe lesions, u-fiber, and Dawson's finger type lesions (the combined criteria) had a mean sensitivity, specificity, PPV, and NPV of 83.66% [95% CI: 76.19% - 89.12%], 90.64% [95% CI: 84.41% - 94.55%], 91.77% [95% CI: 88.07% - 94.39%], and 94.88% [95% CI: 54.57% - 99.65%], respectively. The finding of this study supports the theory that radiological markers have significant potential in the differential diagnosis of MS and NMOSD at baseline, and when utilized alongside clinical manifestations, can further aid physician distinguish the two conditions.