To describe MRI findings in patients with neuromyelitis optica spectrum disorder (NMOSD) from a single tertiary center in South Jersey. 

NMOSD is an autoimmune, inflammatory CNS disease associated with aquaporin-4 antibodies, primarily affecting the optic nerves and spinal cord, but overlapping with multiple sclerosis (MS)  and myelin oligodendrocyte glycoprotein (MOG)-associated disease. Characteristic NMOSD MRI findings include long segment optic neuritis (LSON), longitudinally extensive transverse myelitis (LETM), and lesions involving the periaqueductal grey matter or area postrema. MRI is crucial for early NMOSD recognition and guiding management.  

We conducted a retrospective cohort study, involving 43 NMOSD-diagnosed patients, of electronic medical records between 2000 and 2024. Demographics, clinical presentation, CSF profile, and detailed MRI findings were collected. Descriptive analyses summarized key variables.

The mean age at presentation was 36.5 ± 12.3, and 78.6% were female. Common presenting symptoms were visual disturbances (50%), sensory loss (43%), and lower extremity weakness (40%). Among patients with CSF analysis, 72% demonstrated an inflammatory profile. 43% were aquaporin-4 antibody seropositive. 

At presentation, 75% had abnormal brain MRIs; 64.7% demonstrated spinal cord abnormalities, most often cervical and thoracic transverse myelitis (39.5% each), with 49% being LETM. Furthermore, 16% of abnormal MRIs had central cord lesions, 17% brainstem, 11% area postrema, 7% periaqueductal grey matter, and 3% thalamus. 

Optic neuritis was present in 33.3%; 29% were bilateral, 35% LSON, and 14% involved the chiasm. Steroids were the most common initial therapy and 62% of patients experienced relapses.

MRI abnormalities were frequent and aligned with typical NMOSD findings, most often involving the brain, optic nerves, spinal cord. Lesions in aquaporin-4-rich areas were noted. Many patients demonstrated characteristic features like LETM and optic neuritis, supporting MRI’s diagnostic utility. A limitation is the smaller cohort size; larger, multicenter studies are needed to validate these findings.