IlyaKister, Neurologist, NYU School of Medicine, NYilya.kister@gmail.com
Ilya Kister, Yulin Ge, Joseph Herbert (New York, USA); Tim Sinnecker, Jens Wuerfel, Friedemann Paul (Berlin, Germany)
Submitted May 07, 2013
Matthews et al [1] attempted to differentiate seropositive Neuromyelitis Optica Spectrum Disorders (NMOSD) from MS based on brain MRI records. They suggested that none of the NMOSD patients exhibited 'Dawson's fingers' on brain MRI. James Dawson described these characteristic lesions in MS pathologically as "wedge-shaped areas with broad base to the ventricle, and extensions into adjoining tissue in the form of finger-like processes or ampullae, in each of which a central vessel could usually be found." [2] Ultra-high field MR allows for in vivo visualization of small central veins within 'Dawson's fingers'. Our two groups used ultra-high field MR to image brains in NMOSD and MS and independently reported that periventricular lesions are rare in NMOSD and lack central venule. [3,4]. This supports the authors’ finding that the presence of 'Dawson's fingers' constitutes strong evidence against the diagnosis of NMOSD. However, for this criterion to be useful in clinical practice, an unambiguous definition of what constitutes 'Dawson's finger' on conventional brain MRI must be adopted. It would be helpful if the authors could supply a definition based on their experience with NMOSD and MS that would more formally specify lesion morphology. This should include details on borders, dimensions, and orientation on axial and sagittal T2-weighted sequences. In addition, a defined distance from lateral ventricles and other periventricular lesions would be helpful.
1. Matthews L, Marasco R, Jenkinson M, et al. Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution.
Neurology 2013;80:1330-1337.
2. Dawson JW. The histology of disseminated sclerosis. Transactions of the Royal Society of Edinburgh 1916;50:621.
3. Sinnecker T, Dorr J, Pfueller CF, et al. Distinct lesion morphology at 7-T MRI differentiates neuromyelitis optica from multiple sclerosis.
Neurology2012;79:708-714.
4. Kister I, Herbert J, Zhou Y, Ge Y. Ultrahigh-Field MR (7?T) Imaging of Brain Lesions in Neuromyelitis Optica. Mult Scler Int 2013;2013:398259.
doi: 10.1155/2013/398259.
For disclosures, please contact the editorial office at journal@neurology.org.
Matthews et al [1] attempted to differentiate seropositive Neuromyelitis Optica Spectrum Disorders (NMOSD) from MS based on brain MRI records. They suggested that none of the NMOSD patients exhibited 'Dawson's fingers' on brain MRI. James Dawson described these characteristic lesions in MS pathologically as "wedge-shaped areas with broad base to the ventricle, and extensions into adjoining tissue in the form of finger-like processes or ampullae, in each of which a central vessel could usually be found." [2] Ultra-high field MR allows for in vivo visualization of small central veins within 'Dawson's fingers'. Our two groups used ultra-high field MR to image brains in NMOSD and MS and independently reported that periventricular lesions are rare in NMOSD and lack central venule. [3,4]. This supports the authors’ finding that the presence of 'Dawson's fingers' constitutes strong evidence against the diagnosis of NMOSD. However, for this criterion to be useful in clinical practice, an unambiguous definition of what constitutes 'Dawson's finger' on conventional brain MRI must be adopted. It would be helpful if the authors could supply a definition based on their experience with NMOSD and MS that would more formally specify lesion morphology. This should include details on borders, dimensions, and orientation on axial and sagittal T2-weighted sequences. In addition, a defined distance from lateral ventricles and other periventricular lesions would be helpful.
1. Matthews L, Marasco R, Jenkinson M, et al. Distinction of seropositive NMO spectrum disorder and MS brain lesion distribution. Neurology 2013;80:1330-1337.
2. Dawson JW. The histology of disseminated sclerosis. Transactions of the Royal Society of Edinburgh 1916;50:621.
3. Sinnecker T, Dorr J, Pfueller CF, et al. Distinct lesion morphology at 7-T MRI differentiates neuromyelitis optica from multiple sclerosis. Neurology2012;79:708-714.
4. Kister I, Herbert J, Zhou Y, Ge Y. Ultrahigh-Field MR (7?T) Imaging of Brain Lesions in Neuromyelitis Optica. Mult Scler Int 2013;2013:398259. doi: 10.1155/2013/398259.
For disclosures, please contact the editorial office at journal@neurology.org.