Diagnostic value of bright spotty lesions on MRI after a first episode of acute myelopathy,Journal of Neuroradiology

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Diagnostic value of bright spotty lesions on MRI after a first episode of acute myelopathy
Journal of Neuroradiology ( IF 3.0 ) Pub Date : 2020-05-12 , DOI: 10.1016/j.neurad.2020.04.006
Sylvain Rabasté ₁ , Alvaro Cobo-Calvo ₂ , Veronica Nistiriuc-Muntean ₁ , Sandra Vukusic ₂ , Romain Marignier ₂ , François Cotton ₃ ,

Affiliation

Background and purpose

To determine the diagnostic value of bright spotty lesions (BSLs) for aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD^AQP4+), the predictive value of axial-BSLs for AQP4-IgG seropositivity, and the radio-clinical differences in NMOSD^AQP4+ patients with and without axial-BSLs.

Materials and methods

Retrospective study that included patients aged ≥ 16 years, with a first acute spinal cord syndrome between 2005 and 2018 and abnormal spinal cord MRI with axial and sagittal T2 sequences. Patients with MRI findings consistent with compressive myelopathy were excluded. All spinal cord MRI were retrospectively evaluated for the presence of BSLs by 2 radiologists blinded to the diagnosis of acute myelopathy.

Results

A total of 82 patients were included; 15 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients (NMOSD^AQP4+), and 67 other patients, considered as the other causes of myelopathy (OM) group. The specificity of axial-BSLs for NMOSD^AQP4+ patients was 94.0% (95% CI [85.6 to 97.7]). The sensitivity was 40.0% (95% CI [19.8 to 64.3]). In the multivariable analysis, the only MRI characteristic associated with AQP4-IgG positivity was the presence of axial-BSLs (OR: 9.2, 95% CI [1.2 to 72.9]; P = 0.022). In NMOSD^AQP4+ patients, the median of cord expansion ratio was higher with axial-BSL (1.2, IQR [1.1–1.3]) than without axial-BSL (1.1, IQR [1.0–1.2]; P = 0.046).

Conclusion

After a first acute spinal cord syndrome, the presence of axial-BSLs on spinal cord MRI seems very specific for NMOSD^AQP4+ and seems to be a predictor radiological marker of AQP4-IgG positivity.

中文翻译：

急性脊髓病首次发作后MRI上亮点病变的诊断价值

背景和目的

确定亮点病变 (BSL) 对水通道蛋白 4 抗体阳性视神经脊髓炎谱系障碍 (NMOSD ^AQP4+ ) 的诊断价值、轴向 BSL 对 AQP4-IgG 血清阳性的预测价值，以及 NMOSD ^AQP4+的放射临床差异有和没有轴向 BSL 的患者。

材料和方法

回顾性研究包括年龄 ≥ 16 岁、在 2005 年至 2018 年间首次出现急性脊髓综合征且脊髓 MRI 轴位和矢状位 T2 序列异常的患者。MRI 结果与脊髓压迫症一致的患者被排除在外。由 2 位对急性脊髓病的诊断不知情的放射科医师回顾性评估所有脊髓 MRI 是否存在 BSL。

结果

共纳入 82 名患者；15 名水通道蛋白-4 抗体阳性视神经脊髓炎谱系障碍患者（NMOSD ^AQP4+）和 67 名其他患者，被认为是脊髓病（OM）组的其他原因。NMOSD ^AQP4+患者的轴向 BSL 的特异性为 94.0%（95% CI [85.6 至 97.7]）。灵敏度为 40.0%（95% CI [19.8 至 64.3]）。在多变量分析中，与 AQP4-IgG 阳性相关的唯一 MRI 特征是存在轴向 BSL（OR：9.2，95% CI [1.2 至 72.9]；P = 0.022）。在 NMOSD ^AQP4+患者中，轴向 BSL 的脊髓扩张率中位数（1.2，IQR [1.1-1.3]）高于无轴向 BSL（1.1，IQR [1.0-1.2]；P = 0.046）。