Diagnostic value of bright spotty lesions on MRI after a first episode of acute myelopathy.
Journal of Neuroradiology. 2021-02-01; 48(1): 28-36
DOI: 10.1016/j.neurad.2020.04.006
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Rabasté S(1), Cobo-Calvo A(2), Nistiriuc-Muntean V(1), Vukusic S(2), Marignier
R(2), Cotton F(3); OFSEP, NOMADMUS Study Group.
Collaborators: Bertrand A(4), Xavier A(5), Bourre B(6), Ciron J(7), Cohen M(8),
Collongues N(9), Cotton F(10), Deschamps R(11), Durand-Dubief F(12), Savatovsky
J(13), Laplaud D(14), Maillart E(15), Marignier R(16), Papeix C(17), Ruet A(18),
Kremer S(19), Tourdias T(20), Vukusic S(21), Zephir H(22).
Author information:
(1)Service de radiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon,
69310 Pierre-Bénite, France.
(2)Service de neurologie-sclérose en plaques, pathologies de la myéline et
neuroinflammation, centre de référence des maladies inflammatoires rares du
cerveau et de la moelle (MIRCEM), hospices civils de Lyon, hôpital neurologique
Pierre-Wertheimer, 69500 Bron, France; Inserm U1028, CNRS UMR5292, centre de
recherche en neuroscience de Lyon, université Lyon-1, 69008 Lyon, France.
(3)Service de radiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon,
69310 Pierre-Bénite, France; Inserm U1044, CNRS UMR 5220, CREATIS, université
Lyon-1, 69100 Villeurbanne, France. Electronic address:
.
(4)Hôpital de La Timone, 13005 Marseille, France. Electronic address:
.
(5)Hôpital universitaire de Montpellier, 34000 Montpellier, France. Electronic
address: .
(6)Hôpital universitaire de Rouen, 76000 Rouen, France. Electronic address:
.
(7)Hôpital universitaire de Purpan, 31000 Toulouse, France. Electronic address:
.
(8)Centre hospitalier universitaire de Nice, 06000 Nice, France. Electronic
address: .
(9)Hôpital universitaire de Strasbourg, 67000 Strasbourg, France. Electronic
address: .
(10)Centre hospitalier Lyon-Sud, hospices civils de Lyon, 69000 Lyon, France.
Electronic address: .
(11)Hôpital Fondation Adolphe de Rothschild Paris, 75019 Paris, France.
Electronic address: .
(12)Hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 69000 Lyon,
France. Electronic address: .
(13)Hôpital Fondation Adolphe de Rothschild Paris, 75019 Paris, France.
Electronic address: .
(14)Hôpital universitaire de Nantes, 44000 Nantes, France. Electronic address:
.
(15)Hospital de la Pitié-Salpêtrière, 75013 Paris, France. Electronic address:
.
(16)Hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 69000 Lyon,
France. Electronic address: .
(17)Hôpital Fondation Adolphe de Rothschild Paris, 75019 Paris, France.
Electronic address: .
(18)Hôpital universitaire de Bordeaux, 33000 Bordeaux, France. Electronic
address: .
(19)CHU de Strasbourg, 67000 Strasbourg, France. Electronic address:
.
(20)CHU de Bordeaux, 33000 Bordeaux, France. Electronic address:
.
(21)Hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 69000 Lyon,
France. Electronic address: .
(22)Centre de ressource et competence SEP, 59000 Lille, France. Electronic
address: .
BACKGROUND AND PURPOSE: To determine the diagnostic value of bright spotty
lesions (BSLs) for aquaporin-4 antibody-positive neuromyelitis optica spectrum
disorder (NMOSDAQP4+), the predictive value of axial-BSLs for AQP4-IgG
seropositivity, and the radio-clinical differences in NMOSDAQP4+ 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 (NMOSDAQP4+), and 67 other
patients, considered as the other causes of myelopathy (OM) group. The
specificity of axial-BSLs for NMOSDAQP4+ 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
NMOSDAQP4+ 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 NMOSDAQP4+ and seems to be a
predictor radiological marker of AQP4-IgG positivity.
Copyright © 2020 Elsevier Masson SAS. All rights reserved.
DOI: 10.1016/j.neurad.2020.04.006
PMID: 32407908 [Indexed for MEDLINE]