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

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).

We studied the correlation between conventional non-standardized magnetic resonance imaging (MRI) parameters, PE treatment, and clinical data obtained at nadir and recovery.

Retrospective study of first SC attacks of NMOSD.

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.

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.