Spinal cord and brain MRI should be routinely performed during follow-up in patients with NMOSD – Yes

Contentti, Edgar Carnero; Correale, Jorge

doi:10.1177/1352458520960804

Cited by 2 publications

(5 citation statements)

References 10 publications

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“…However, the presence of ASLs did not exhibit a statistically significant impact on subsequent relapses in multivariate analyses. Another study also showed that the presence of new asymptomatic MRI lesions during the relapse‐free period was not associated with a shorter time to develop subsequent relapses 10 . We speculated that this might be related to treatments and immunosuppressant switches after ASL detection.…”

Section: Discussionmentioning

confidence: 78%

“…baseline and enabling comparisons with future relapses. 11,12 The Latin American NMOSD Consensus recently recommended annual brain MRIs for NMOSD patients after starting immunosuppressive therapy to complement clinical follow-ups. 13 Acute myelitis, a primary core symptom of NMOSD, frequently presents as longitudinally extensive transverse myelitis (LETM) in about 70% of cases and as short transverse myelitis (STM) in roughly 20% of cases.…”

Section: Introductionmentioning

confidence: 99%

“…In MS, the presence of new asymptomatic lesions on MRI aids in diagnosing the disease in patients with clinically isolated syndromes and can be used for therapeutic monitoring and prognostic assessment 3 . In contrast, disability accumulation in NMOSD seems closely linked to attacks, with asymptomatic lesions indicating ongoing disease activity found in only a small fraction of NMOSD patients 4–10 . These asymptomatic lesions can emerge during attacks or remission, suggesting MRI's heightened sensitivity compared to clinical symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…These asymptomatic lesions can emerge during attacks or remission, suggesting MRI's heightened sensitivity compared to clinical symptoms. Performing a one‐off MRI scan following an acute episode seems reasonable, allowing a reestablishment of the imaging baseline and enabling comparisons with future relapses 11,12 . The Latin American NMOSD Consensus recently recommended annual brain MRIs for NMOSD patients after starting immunosuppressive therapy to complement clinical follow‐ups 13 …”

Section: Introductionmentioning

confidence: 99%

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Asymptomatic spinal lesions in patients with AQP4‐IgG‐positive NMOSD: A real‐world cohort study

Cao,

Zhu,

et al. 2024

Ann Clin Transl Neurol

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ObjectiveThis study aims to explore the frequency and influencing factors of asymptomatic spinal lesions (ASLs) and their impact on subsequent relapses in patients with AQP4‐IgG‐positive NMOSD (AQP4‐NMOSD) in a real‐world setting.MethodsWe retrospectively reviewed clinical information and spinal MRI data from AQP4‐NMOSD patients who had at least one spinal cord MRI during their follow‐ups. Kaplan–Meier curves and Cox proportional hazards models were employed to ascertain potential predictors of remission ASLs and to investigate factors associated with subsequent relapses.ResultsIn this study, we included 129 patients with AQP4‐NMOSD and reviewed 173 spinal MRIs during attacks and 89 spinal MRIs during remission. Among these, 6 ASLs (3.5%) were identified during acute attacks, while 8 ASLs (9%) were found during remission. Remission ASLs were linked to the use of immunosuppressive agents, particularly conventional ones, whereas no patients using rituximab developed ASLs (p = 0.005). Kaplan–Meier curve analysis indicated that patients with ASLs had a significantly higher relapse risk (HR = 4.658, 95% CI: 1.519–14.285, p = 0.007) compared to those without. Additionally, the use of mycophenolate mofetil (HR = 0.027, 95% CI: 0.003–0.260, p = 0.002) and rituximab (HR = 0.035, 95% CI: 0.006–0.203, p < 0.001) significantly reduced the relapse risk. However, after accounting for other factors, the presence of ASLs did not exhibit a significant impact on subsequent relapses (HR = 2.297, 95% CI: 0.652–8.085, p = 0.195).InterpretationASLs may be observed in patients with AQP4‐NMOSD. The presence of ASLs may signify an underlying inflammatory activity due to insufficient immunotherapy. The administration of immunosuppressive agents plays a key role in the presence of remission ASLs and the likelihood of subsequent relapses.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Asymptomatic spinal lesions in patients with AQP4‐IgG‐positive NMOSD: A real‐world cohort study

Cao,

Zhu,

et al. 2024

Ann Clin Transl Neurol

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“…While typical or suggestive MRI lesions were reported in up to 53% of NMOSD patients 16 (even at disease onset), 17 there is an extensive debate on the frequency and the impact of asymptomatic MRI lesions, and the need of routine MRI at follow-up in patients without relapses is still controversial. 18–20 In this context, studying the longitudinal evolution of MRI lesions after an initial attack may improve our understanding on subclinical activity of the disease and may help to plan specific strategies for monitoring disease activity and treatment. Although there is no consensus worldwide on MRI use during follow-up, a Latin American NMOSD consensus recently published, 21 using formal methodology (RAND/UCLA), has recommended annual brain MRI use among NMOSD patients after initiating specific treatment as a complementary control at clinical follow-up.…”

Section: Discussionmentioning

confidence: 99%

Frequency of new asymptomatic MRI lesions during attacks and follow-up of patients with NMOSD in a real-world setting

et al. 2023

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Background: We aimed to assess the frequency of new asymptomatic lesions on brain and spinal imaging (magnetic resonance imaging (MRI)) and their association with subsequent relapses in a large cohort of neuromyelitis optica spectrum disorder (NMOSD) patients in Argentina. Methods: We retrospectively reviewed 675 MRI (225 performed during an attack and 450 during the relapse-free period (performed at least 3 months from the last attack)) of NMOSD patients who had at least 2 years of clinical and MRI follow-up since disease onset. Kaplan–Meier (KM) curves were used for depicting time from remission MRI to subsequent relapse. Results: We included 135 NMOSD patients (64.4% were aquaporin-4-immunoglobulin G (AQP4-IgG)-positive). We found that 26 (19.26%) and 66 (48.88%) of patients experienced at least one new asymptomatic MRI lesion during both the relapse-free period and attacks, respectively. The most frequent asymptomatic MRI lesions were optic nerves followed by short-segment myelitis during the relapse-free period and attacks. KM curves did not show differences in the time taken to develop a new relapse. Conclusion: Our findings showed that new asymptomatic lesions are relatively frequent. However, the presence of new asymptomatic MRI lesions during the relapse-free period and at relapses was not associated with a shorter time to developing subsequent relapses.

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Spinal cord and brain MRI should be routinely performed during follow-up in patients with NMOSD – Yes

Cited by 2 publications

References 10 publications

Asymptomatic spinal lesions in patients with AQP4‐IgG‐positive NMOSD: A real‐world cohort study

Asymptomatic spinal lesions in patients with AQP4‐IgG‐positive NMOSD: A real‐world cohort study

Frequency of new asymptomatic MRI lesions during attacks and follow-up of patients with NMOSD in a real-world setting

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