Gadolinium (Gd)-contrast MRI for reliable detection of blood–brain barrier (BBB) breakdown is widely used in neuromyelitis optica spectrum disorder (NMOSD) attack. Nonetheless, little is known about the predictive role of gadolinium-enhancing lesion in prognosis of NMOSD attack. The aim of this work is to investigate the predictive value of persistently Gd-enhanced lesions to medium-term outcome after attack. Data for this analysis came from an ongoing prospective cohort study (CLUE). NMOSD patients with acute attack were enrolled from January 2019 to March 2020. All patients underwent Gd-contrast MRI at baseline and 1 month, and disability was assessed by Expanded Disability Status Scale (EDSS). Primary outcome was EDSS improvement from baseline to month 6. Multiple logistic regression identified predictors for poor recovery of NMOSD attack. Forty-one participants were analyzed, of which 21 patients had persistently Gd-enhancing lesions. Patients in no enhancement (NE) group showed a significant shift in 6-month EDSS distributions compared with those in persistent enhancement (PE) group (p = 0.005). Poor recovery rate of the PE group was higher than that of the NE group at 6 months (p = 0.033). In patients with aquaporin-4-positive, first-attack, transverse myelitis or in a high-dose steroid treatment subgroup, the improvement of EDSS scores in the PE group was still less compared with that in the NE group (p < 0.05). The presence of persistently Gd-enhancing lesion appears to be associated with poor recovery after attack (OR = 5.473, p = 0.014). Our study found that persistently gadolinium-enhancing lesion is a poor prognosis predictor after NMOSD attack. Trial registration ID: NCT04106830

钆 (Gd) 对比 MRI 可可靠检测血脑屏障 (BBB) 破坏，广泛用于视神经脊髓炎谱系障碍 (NMOSD) 发作。尽管如此，关于钆增强病变在 NMOSD 发作预后中的预测作用知之甚少。这项工作的目的是研究持续 Gd 增强的病变对发作后中期结果的预测价值。此分析的数据来自正在进行的前瞻性队列研究 (CLUE)。入组2019年1月至2020年3月急性发作的NMOSD患者。所有患者在基线和1个月时均接受Gd对比MRI，并采用扩展残疾状态量表（EDSS）评估残疾。主要结果是 EDSS 从基线到第 6 个月的改善。多重逻辑回归确定了 NMOSD 攻击恢复不良的预测因素。对 41 名参与者进行了分析，其中 21 名患者患有持续性 Gd 增强病变。与持续增强 (PE) 组患者相比，无增强 (NE) 组患者的 6 个月 EDSS 分布出现显着变化 ( p = 0.005)。 6个月时PE组的不良恢复率高于NE组（ p = 0.033）。在水通道蛋白 4 阳性、首次发作、横贯性脊髓炎或大剂量类固醇治疗亚组的患者中，PE 组 EDSS 评分的改善仍小于 NE 组（ p < 0.05）。持续 Gd 增强病变的存在似乎与发作后恢复不良有关（OR = 5.473， p = 0.014）。我们的研究发现，持续性钆增强病变是 NMOSD 发作后预后不良的预测因素。试用注册 ID：NCT04106830