Neuromyelitis optica spectrum disorder echocardiography or ultrasound
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Julinka Auta Fernandes
Overview
Neuromyelitis optica spectrum disorder (NMOSD) has no established disease-specific echocardiographic or ultrasonographic diagnostic criteria. Diagnosis depends on the clinical presentation, serum aquaporin-4 immunoglobulin G (AQP4-IgG) antibody testing, magnetic resonance imaging (MRI), and exclusion of alternative diagnoses.[1]
The 2026 Middle East and North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) guidelines endorse the 2015 International Panel for Neuromyelitis Optica Diagnosis (IPND) criteria and emphasize serum AQP4-IgG testing using cell-based assays.[2]
Key Echocardiography/Ultrasound Findings in Neuromyelitis Optica Spectrum Disorder
Echocardiography
Neuromyelitis optica spectrum disorder has no established diagnostic echocardiographic findings. Echocardiography is not included as an NMOSD diagnostic test in the workup described by the Neuromyelitis Optica Study Group (NEMOS).[3]
Transorbital Ultrasonography
Neuromyelitis optica spectrum disorder-associated optic neuritis has been evaluated using transorbital ultrasonography, but published case observations do not establish its diagnostic accuracy or a routine monitoring role.[4]
- In one AQP4-IgG-positive case, ultrasound demonstrated increased optic nerve sheath diameter during optic neuritis. A subsequent relapse also showed optic disc elevation; these abnormalities decreased after treatment.[4]
- These single-case observations do not establish an NMOSD-specific ultrasound pattern or validated diagnostic measurement thresholds.[4]
- Transorbital ultrasound findings do not replace the clinical assessment, antibody testing, or MRI required by the diagnostic framework. NEMOS recommends cranial and spinal MRI, with orbital MRI in selected patients; optical coherence tomography (OCT) and visual evoked potentials may provide additional supportive information.[1][3]
Ultrasound for Urinary Tract Complications
Neuromyelitis optica spectrum disorder can cause bladder dysfunction in association with myelitis.[3] In patients with neurogenic urinary dysfunction, the 2026 European Association of Urology (EAU) neuro-urology guidelines support assessment of residual urine and urinary tract imaging. These are general neuro-urology recommendations applied to patients with NMOSD and urinary dysfunction.[5]
- Bladder assessment: Bladder ultrasound can assess post-void residual urine, helping identify incomplete bladder emptying.[5]
- Upper urinary tract assessment: Renal ultrasound can assess the upper urinary tract; regular surveillance is recommended in patients at high risk of urinary tract damage.[5]
- Follow-up: Imaging frequency should be individualized according to urinary tract risk, clinical changes, and the treatment plan.[5]
References
- ↑ 1.0 1.1 Wingerchuk DM, Banwell B, Bennett JL, et al. (2015). "International consensus diagnostic criteria for neuromyelitis optica spectrum disorders". Neurology. 85 (2): 177–189. doi:10.1212/WNL.0000000000001729. PMC 4515040. PMID 26092914.
- ↑ Yamout B, Gouider R, Al-Roughani R, et al. (2026). "Consensus Recommendations for the Diagnosis and Treatment of Neuromyelitis Optica Spectrum Disorders (NMOSD): The MENACTRIMS Guidelines". CNS Drugs. 40 (3): 283–303. doi:10.1007/s40263-025-01260-x. PMID 41591715 Check
|pmid=value (help). - ↑ 3.0 3.1 3.2 Jarius S, Aktas O, Ayzenberg I, et al. (2023). "Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis". Journal of Neurology. 270: 3341–3368. doi:10.1007/s00415-023-11634-0. PMC 10267280 Check
|pmc=value (help). - ↑ 4.0 4.1 4.2 Montabone C, Nardone R, Siniscalchi A, Coppo L, Naldi A, Lochner P (2022). "Transorbital Sonography for Monitoring Neuromyelitis Optica: a Case Report". SN Comprehensive Clinical Medicine. 4: 150. doi:10.1007/s42399-022-01229-7.
- ↑ 5.0 5.1 5.2 5.3 European Association of Urology (2026). "EAU Guidelines on Neuro-urology: The Guideline". Uroweb. Sections 3.3.6, 3.3.6.b, and 3.7. Retrieved 2026-10-30.