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Combined brain and anterior visual pathways’ MRIs assist in early identification of neuromyelitis optica spectrum disorder at onset of optic neuritis

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Abstract

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.

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Acknowledgements

The authors thank Laura McMaster for careful review of the manuscript.

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Authors and Affiliations

  1. Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France

    D. Buch, O. Gout & R. Deschamps

  2. Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France

    J. Savatovsky

  3. Department of Neuro-Ophthalmolology, Fondation Ophtalmologique Adolphe de Rothschild, 75019, Paris, France

    C. Vignal

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  1. D. Buch
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  2. J. Savatovsky
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Correspondence to D. Buch.

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Dr. Buch, Dr. Gout, Dr. Vignal and Dr. Deschamps declare that they have no financial or other conflicts of interest to this research and its publication. Dr. Savatovsky reports grants from ANRS, other from Bayer, other from Philips, non-financial support from GE Healthcare, other from IRIS, outside the submitted work.

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All procedures were in accordance with the ethical standards of the institutional and national research committee.

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This study was a retropsective and observational analysis of anonymized data.

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Buch, D., Savatovsky, J., Gout, O. et al. Combined brain and anterior visual pathways’ MRIs assist in early identification of neuromyelitis optica spectrum disorder at onset of optic neuritis. Acta Neurol Belg 117, 67–74 (2017). https://doi.org/10.1007/s13760-016-0714-2

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  • DOI: https://doi.org/10.1007/s13760-016-0714-2

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