Predictive value of conventional MRI parameters in first spinal attacks of neuromyelitis optica spectrum disorder

Abstract

Background: While spinal cord (SC) attacks of neuromyelitis optica spectrum disorder (NMOSD) are often devastating, signs predictive of their poor clinical outcome have been elusive until now, except for the delay in initiating plasma exchange (PE). Objective: We studied the correlation between conventional non-standardized magnetic resonance imaging (MRI) parameters, PE treatment, and clinical data obtained at nadir and recovery. Methods: Retrospective study of first SC attacks of NMOSD. Results: Sixty-nine Afro-Caribbean NMOSD patients were included (aquaporin-4 (AQP4) antibodies positive in 65%). Median nadir and residual expanded disability status score (EDSS) were, respectively, 7.5 and 4.0. In bivariate analysis, all conventional MRI parameters were correlated with nadir and residual EDSS. In multivariate analysis, nadir EDSS correlated with lesion length ( p = 0.022) and edema ( p = 0.019), whereas residual EDSS correlated with T1w (T1-weighted) hypointense signal ( p = 0.003). Gadolinium enhancement was not associated with outcome. Conclusion: A specific pattern of lesions in conventional MRI data is differentially associated with nadir and residual EDSS. Lesions associated with poor prognosis should prompt highly efficient treatment.

Expression and Clinical Correlation Analysis Between Repulsive Guidance Molecule a and Neuromyelitis Optica Spectrum Disorders

“…The length of spinal lesions is correlated with inflammatory activity and neurological impairment (21,37) and is correlated with disease severity based on the admission EDSS score (38,39). Our study demonstrated for the first time that RGMa levels were positively correlated with the length of spinal lesions on NMOSD MRI scans.…”

Monocyte to High-Density Lipoprotein Ratio: A Novel Predictive Marker of Disease Severity and Prognosis in Patients With Neuromyelitis Optica Spectrum Disorders

“…In our study, univariate analysis showed that spinal cord MRI showing LETM had a moderate influence on the initial EDSS score and prognosis of NMOSD, but there was no significant correlation in multivariate analysis, and previous studies have found that the length of spinal cord lesions is related to the initial severity of the disease and residual disability (59). The ability of MRI parameters to predict NMOSD prognosis requires further exploration.…”

Update on neuromyelitis optica spectrum disorder

“…Women with NMOSD have a higher percentage of pregnancy loss than expected for age. 52 Additional clinical factors that have been associated with increased relapse risk or worse disability include brainstem-onset attacks, 47,53 longer length of myelitis lesions, 33,54 optic neuritis at disease onset, 55 and severity of initial attack. 45,49 There does not seem to be a correlation between outcomes and gadolinium enhancement of CNS lesions.…”

“…45,49 There does not seem to be a correlation between outcomes and gadolinium enhancement of CNS lesions. 54 As far as serologic testing, the titer of AQP4-IgG has not been shown to correlate with disease severity or prognosis. 56 However, in comparison with MOG antibody disease, AQP4-Ab positive and double seronegative NMOSD correlate with worse disability.…”