Neuromyelitis optica spectrum disorder other imaging findings
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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) can be evaluated with optical coherence tomography (OCT) to assess retinal injury. The Neuromyelitis Optica Study Group (NEMOS) recommends OCT for supportive diagnostic information, although it is not formally required for diagnosis.[1]
Conventional magnetic resonance imaging (MRI) findings are described on the NMOSD MRI page.
Key Optical Coherence Tomography Findings in Neuromyelitis Optica Spectrum Disorder
Neuromyelitis optica spectrum disorder-associated optic neuritis can produce substantial retinal neuroaxonal loss, including after the first attack.[2]
- Peripapillary retinal nerve fiber layer (pRNFL): Thinning reflects loss of retinal nerve fibers following optic neuritis.[2]
- Ganglion cell–inner plexiform layer (GCIPL): Thinning indicates retinal neuroaxonal injury and may be associated with reduced visual acuity.[2]
- Microcystic macular edema: Microcystic changes may occur within the inner nuclear layer.[2]
Acquisition and Interpretation
Neuromyelitis optica spectrum disorder assessment with OCT should include a high-resolution macular volume scan and a peripapillary ring scan. Images must be checked for adequate quality and segmentation errors.[1]
OCT findings alone do not establish NMOSD. Their ability to reliably distinguish NMOSD from multiple sclerosis and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is limited; interpretation requires the clinical presentation, antibody results, and MRI findings.[1]
Optical Coherence Tomography Angiography
Neuromyelitis optica spectrum disorder has been associated with retinal microvascular changes on optical coherence tomography angiography (OCTA). An exploratory cross-sectional study reported enlargement of the foveal avascular zone and superficial retinal vessel loss, including changes in eyes without previous optic neuritis. These findings remain investigational and are not established diagnostic criteria.[3]
Advanced Imaging
Neuromyelitis optica spectrum disorder research also uses non-conventional MRI to investigate microstructural damage, inflammatory activity, and tissue repair. The 2026 Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) consensus discusses these techniques alongside conventional MRI for diagnosis, monitoring, and research.[4]
References
- ↑ 1.0 1.1 1.2 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). - ↑ 2.0 2.1 2.2 2.3 Oertel FC, Specovius S, Zimmermann HG, et al. (2021). "Retinal Optical Coherence Tomography in Neuromyelitis Optica". Neurology: Neuroimmunology & Neuroinflammation. 8 (6): e1068. doi:10.1212/NXI.0000000000001068. PMC 8448522 Check
|pmc=value (help). - ↑ Aly L, Strauß EM, Feucht N, et al. (2022). "Optical coherence tomography angiography indicates subclinical retinal disease in neuromyelitis optica spectrum disorders". Multiple Sclerosis. 28 (4): 522–531. doi:10.1177/13524585211028831. PMC 8961243 Check
|pmc=value (help). PMID 34259579 Check|pmid=value (help). - ↑ Cortese R, Hacohen Y, Arrambide G, et al. (2026-09-28). "Use of MRI in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease - MAGNIMS consensus recommendations". Nature Reviews Neurology. doi:10.1038/s41582-026-01271-2. PMID 42806097 Check
|pmid=value (help).