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MRI Features and Their Association With Outcomes in Children With Anti-NMDA Receptor Encephalitis
Grace Gombolay1, J Nicholas Brenton2, Jennifer H Yang2
1From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.). grace.yoonheekim.gombolay@emory.edu.
Objectives:
How brain MRI lesions associate with outcomes in pediatric anti-NMDA receptor encephalitis (pNMDARE) is unknown. In this study, we correlate T2-hyperintense MRI brain lesions with clinical outcomes in pNMDARE.
Methods:
This was a multicenter retrospective cohort study from 11 institutions. Children younger than 18 years with pNMDARE were included. One-year outcomes were assessed by the modified Rankin Score (mRS) with good (mRS ≤2) and poor (mRS ≥3) outcomes.
Results:
A total of 175 pNMDARE subjects were included, with 1-year mRS available in 142/175 (81%) and 60/175 (34%) had abnormal brain MRIs. The most common T2-hyperintense lesion locations were frontal, temporal, and parietal. MRI features that predicted poor 1-year outcomes included abnormal MRI, particularly T2 lesions in the frontal and occipital lobes. After adjusting for treatment within 4 weeks of onset, improvement within 4 weeks, and intensive care unit admission, MRI features were no longer associated with poor outcomes, but after multiple imputation for missing data, T2 frontal and occipital lesions associated with poor outcomes.
Discussion:
Abnormal frontal and occipital lesions on MRI may associate with 1-year mRS in pNMDARE. MRI of the brain may be a helpful prognostication tool that should be examined in future studies.
Insights
Brain MRI T2 lesions in pediatric anti-NMDA receptor encephalitis (pNMDARE) may predict outcomes. Frontal and occipital lesions showed association with poor 1-year prognosis in children with pNMDARE.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimaging
Background:
- Pediatric anti-NMDA receptor encephalitis (pNMDARE) is a severe autoimmune neurological disorder.
- The association between brain MRI findings and clinical outcomes in pNMDARE remains unclear.
- Understanding prognostic markers is crucial for managing pediatric encephalitis.
Purpose of the Study:
- To investigate the correlation between T2-hyperintense brain MRI lesions and 1-year clinical outcomes in pediatric anti-NMDA receptor encephalitis (pNMDARE).
- To determine if specific MRI lesion locations can serve as a prognostic tool in pNMDARE.
Main Methods:
- A multicenter retrospective cohort study included 175 children (<18 years) diagnosed with pNMDARE.
- One-year outcomes were assessed using the modified Rankin Scale (mRS), categorizing outcomes as good (mRS ≤2) or poor (mRS ≥3).
- Brain MRI findings, particularly T2-hyperintense lesions, were analyzed for location and association with outcomes.
Main Results:
- Of 175 subjects, 142 (81%) had available 1-year outcome data. Abnormal brain MRIs were present in 34% (60/175) of patients.
- Common T2-hyperintense lesion sites included frontal, temporal, and parietal lobes.
- Initially, frontal and occipital T2 lesions predicted poor outcomes. However, after adjusting for clinical factors, this association was lost. Multiple imputation revealed that frontal and occipital T2 lesions were significantly associated with poor 1-year outcomes.
Conclusions:
- Abnormal frontal and occipital T2 lesions on brain MRI may be associated with 1-year modified Rankin Scale scores in pediatric anti-NMDA receptor encephalitis.
- Brain MRI, specifically lesion location, warrants further investigation as a potential prognostication tool in pNMDARE.
- Future research should focus on validating MRI findings for predicting long-term outcomes in pediatric encephalitis.
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