Role of clinicoradiological correlation in evaluation of various demyelinating disorders: A Systematic review

Abstract

Background: There are mainly three types of white matter disorders resulting from defective myelination (dysmyelinating), destruction of myelin (demyelination) and decreased myelination (hypomyelinating). Each of these disorders require MRI and specific imaging for diagnosis. However, diagnosis of white matter disorders cannot solely rely on imaging. Objective: In this review we aim to correlate clinical presentation, history, laboratory investigations, and imaging as a tool rather than diagnostic modality to highlight the importance of clinical and radiological collaboration to diagnose the exact disease process. We would specifically discuss variants of multiple sclerosis, acute disseminated encephalomyelitis, neuromyelitis Optica spectrum disorder, progressive multifocal leuckoencephalothy, and osmotic demyelination syndrome. This study also includes specific signs of different demyelination white matter disorders on MRI which are characteristic of that disease process. However, we also highlight what clinical correlation and investigations may further aid to confirm the diagnosis, prognosis and extent of disease progression. Methods: In this review article we used Prisma guidelines we extracted studies where there was evidence of better patient outcome in terms of clinicoradiological collaboration in diagnosing various demyelinating white matter disorders. Results: We found that timely diagnosis and better patient outcomes can be achieved if clinicians also take in accord their own clinical judgement and based on that order relevant radiological investigations resulting better clinician to clinician communication, judicious use of hospital resources and overall better outcome in disease process. Conclusion: Our study concludes that solid clinical judgement, laboratory investigations along with radiological features of disease process would enhance clinical outcomes in terms of timely diagnosis, specific treatment and tracking disease prognosis.