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OImaging features to distinguish AQP4-positive NMOSD and MS at disease onset: a retrospective analysis in a single-center cohort

Published:November 22, 2021DOI:https://doi.org/10.1016/j.ejrad.2021.110063

      Abstract

      Purpose

      To compare the diagnostic performance of imaging criteria that differentiate AQP4+ Neuromyelitis Optica Spectrum Disorders (NMOSD) and Multiple Sclerosis (MS) at disease onset (DO) and follow-up (FU).

      Methods

      We retrospectively analyzed MRI scans at DO (defined as the first 60 days of patient-reported symptom onset) in 10 AQP4+NMOSD and 25 (time to MRI matched) relapsing-remitting MS patients from a monocentric cohort.

      Results

      The Matthews criteria were met in 20% of AQP4+NMOSD patients at DO vs. 33% at FU, and in 96% of RRMS patients vs.100% at FU. Specificity (SP) and sensitivity (SE) were thus high at both time-points: SP-DO: 96%; SP-FU:100%; and SE-DO: 80%; SE-FU: 67%, with similar area under the curve (AUC) values at DO: 88% [95% CI 74%-100%] and FU: 83% [95% CI 67%-100%].
      The Cacciaguerra criteria were met in 90% of AQP4+NMOSD patients at DO vs. 88.9% at FU and in 24% of RRMS patients vs. 14% at FU; SP-DO: 87%; SP-FU: 86%; and SE-DO: 90%; SE-FU: 89%, with similar AUC values at DO: 88% [95% CI 76%-98%] and FU: 87% [95% CI 74%-98%].

      Conclusions

      While diagnostic MRI criteria were developed on data acquired years after disease onset, our study demonstrates their high applicability at the earliest disease stages, thus emphasising their valuable use in clinical practice.

      Keywords

      Abbreviations:

      AUC (area under the curve), AQP4 (aquaporin 4), CC (Cacciaguerra criteria), DO (disease onset), FU (Follow-up), IPND (International Consensus Diagnostic Criteria Neuromyelitis Optica Spectrum Disorders), LETM (longitudinal extensive transverse myelitis), McD-DIS (2017 McDonald criteria for dissemination in space), MC (Matthews criteria), MS (Multiple Sclerosis), NA (not applicable), NMOSD (Neuromyelitis Optica Spectrum Disorder), OCB (Cerebrospinal fluid oligoclonal bands), ONbilat. ant. (opticus neuritis bilateral nterior), ON chiasm. (opticus neuritis involving chiasma), ONunilat. ant. (opticus neuritis unilateral anterior), Peri-ependymal LVL (peri-ependymal lesions along the lateral ventricles), PWM (periventricular white matter), RRMS (relapsing-remitting MS), WM (white matter), IL (infratentorial lesion), JC (juxtacortical lesion count), SC GAD+ lesion (spinal cord gadolinium-enhancing lesion), SC segments (spinal cord longitudinal extension measured in vertebral segments), SCL (spinal cord lesions), Temp. L (temporal lobe), TL (total lesion count)
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