Combined brain and anterior visual pathways' MRIs assist in early identification of neuromyelitis optica spectrum disorder at onset of optic neuritis.
Acute optic neuritis (ON) is the initial presentation in half of neuromyelitis optica spectrum disorder (NMO-SD) cases. Our objective was to evaluate accuracy of combined MRIs of the anterior visual pathways and of the brain to correctly identify NMO-SD among patients with acute ON. We performed a retrospective study on patients with acute ON in NMO-SD (16 episodes) and first-event non-NMO-SD (32 episodes). All MRIs included exams of the brain and anterior visual pathways using T2-weighted and post-gadolinium T1-weighted coronal thin slices. Images were reviewed by a neuroradiologist who was blinded to the final diagnosis. There were no multiple sclerosis (MS)-like lesions with dissemination in space (DIS) with NMO-SD (0 vs. 53%, p < 0.01). Non-NMO-SD ON usually spared the chiasma (3 vs. 44%, p < 0.01) and the optic tracts (0 vs. 19%, p < 0.01). Optic nerve lesions were longer [median (range) 26 mm (14-64) vs. 13 mm [8-36], p < 0.01] and the number of segments involved higher (3 [1-8] vs. 1 [1-4], p < 0.01) in NMO-SD. Bilateral optic nerve involvement, or involvement of ≥3 segments, or involvement of the chiasma, or optic tracts in the absence of MS-like lesions with DIS were suggestive of NMO-SD with a sensitivity of 69% (CI 95% 41-89) and a specificity of 97% (CI 95% 84-99) (p < 0.01). Combining brain and anterior visual pathways' MRIs seems efficient for detecting acute ON patients who are at high risk for NMO-SD.
Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France. danbuchdan@gmail.com.
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Buch
Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France.
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Savatovsky
Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France.
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Gout
Department of Neuro-Ophthalmolology, Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France.
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Vignal
Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France.
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Deschamps
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D009471:Neuromyelitis Optica / Q000150:complications / Q000000981:diagnostic imaging*; D009902:Optic Neuritis / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D014795:Visual Pathways / Q000000981:diagnostic imaging; D055815:Young Adult
Chiasma; Extensive; MRI; Multiple sclerosis; Neuromyelitis optica; Optic neuritis