{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:03:21Z","timestamp":1775840601468,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,10,9]],"date-time":"2017-10-09T00:00:00Z","timestamp":1507507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003803","name":"University of Hong Kong","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003803","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are central nervous system (CNS) inflammatory demyelinating disorders. It is clinically important to distinguish MS from NMOSD, as treatment and prognosis differ. Brainstem involvement is common in both disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate whether the patterns of brainstem atrophy on volumetric analysis in MS and NMOSD were different and correlated with clinical disability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Type<\/jats:title><jats:p>Case\u2013control cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects<\/jats:title><jats:p>In all, 17 MS, 13 NMOSD, and 18 healthy control (HC) subjects were studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Field Strength\/Sequence<\/jats:title><jats:p>T<jats:sub>1<\/jats:sub>\u2010weighted and T<jats:sub>2<\/jats:sub>w spin\u2010echo images were acquired with a 3T scanner.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>Semiautomated segmentation and volumetric measurement of brainstem regions were performed. Anatomical information was obtained from whole brain T<jats:sub>1<\/jats:sub>w images using a 3D magnetization\u2010prepared rapid gradient\u2010echo (MPRAGE) imaging sequence (TR\/TE\/T: 7.0\/3.2\/800 msec, voxel size: 1 \u00d7 1 \u00d7 1 mm<jats:sup>3<\/jats:sup>, scan time: 10\u2009min 41 sec).<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>Independent samples <jats:italic>t<\/jats:italic>\u2010test, Mann\u2013Whitney <jats:italic>U<\/jats:italic>\u2010test, partial correlation, and multiple regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline characteristics were similar across the three groups, without significant difference in disease duration (<jats:italic>P<\/jats:italic>\u2009=\u20090.354) and EDSS score (<jats:italic>P<\/jats:italic>\u2009=\u20090.159) between MS and NMOSD subjects. Compared to HC, MS subjects had significantly smaller normalized whole brainstem (\u22125.2%, <jats:italic>P<\/jats:italic>\u2009=\u20090.027), midbrain (\u22128.3%, <jats:italic>P<\/jats:italic>\u2009=\u20090.0001), and pons volumes (\u22125.9%, <jats:italic>P<\/jats:italic>\u2009=\u20090.048), while only the normalized medulla volume was significantly smaller in NMOSD subjects compared to HC (\u22128.5% vs. HC, <jats:italic>P<\/jats:italic>\u2009=\u20090.024). Normalized midbrain volume was significantly smaller in MS compared to NMOSD subjects (\u22125.0%, <jats:italic>P<\/jats:italic>\u2009=\u20090.014), whereas normalized medulla volume was significantly smaller in NMOSD compared to MS subjects (\u22128.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.032). Partial correlations and multiple regression analysis revealed that smaller normalized whole brainstem, pons, and medulla oblongata volumes were associated with greater disability on the Expanded Disability Status Scale (EDSS), Functional System Score (FSS)\u2010brainstem and FSS\u2010cerebellar in NMOSD subjects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Conclusion<\/jats:title><jats:p>Differential patterns of brainstem atrophy were observed, with the midbrain being most severely affected followed by pons in MS, whereas only the medulla oblongata was affected in NMOSD.<\/jats:p><jats:p><jats:bold>Level of Evidence:<\/jats:bold> 2<\/jats:p><jats:p><jats:bold>Technical Efficacy:<\/jats:bold> Stage 3<\/jats:p><jats:p>J. Magn. Reson. Imaging 2018;47:1601\u20131609.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.25866","type":"journal-article","created":{"date-parts":[[2017,10,9]],"date-time":"2017-10-09T05:48:45Z","timestamp":1507528125000},"page":"1601-1609","source":"Crossref","is-referenced-by-count":33,"title":["Differential brainstem atrophy patterns in multiple sclerosis and neuromyelitis optica spectrum disorders"],"prefix":"10.1002","volume":"47","author":[{"given":"Chi\u2010Yan","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Medicine University of Hong Kong Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry Ka\u2010Fung","family":"Mak","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology University of Hong Kong  Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pui\u2010Wai","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology University of Hong Kong  Hong 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