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Review
. 2021 May 9:14:17562864211014389.
doi: 10.1177/17562864211014389. eCollection 2021.

A window into the future? MRI for evaluation of neuromyelitis optica spectrum disorder throughout the disease course

Jacqueline M Solomon  1 , Friedemann Paul  2 , Claudia Chien  2 , Jiwon Oh  1 , Dalia L Rotstein  3
Affiliations
Review

A window into the future? MRI for evaluation of neuromyelitis optica spectrum disorder throughout the disease course

Jacqueline M Solomon et al. Ther Adv Neurol Disord. .

Abstract

Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing, inflammatory disease of the central nervous system marked by relapses often associated with poor recovery and long-term disability. Magnetic resonance imaging (MRI) is recognized as an important tool for timely diagnosis of NMOSD as, in combination with serologic testing, it aids in distinguishing NMOSD from possible mimics. Although the role of MRI for disease monitoring after diagnosis is not as well established, MRI may provide important prognostic information and help differentiate between relapses and pseudorelapses. Increasing evidence of subclinical disease activity and the emergence of newly approved, highly effective immunotherapies for NMOSD adjure us to re-evaluate MRI as a tool to guide optimal treatment selection and escalation throughout the disease course. In this article we review the role of MRI in NMOSD diagnosis, prognostication, disease monitoring, and treatment selection.

Keywords: MRI; NMOSD; disease activity; prognosis.

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Conflict of interest statement

Conflict of interest statement: J. Solomon has no disclosures to declare. F. Paul is named as a coinventor on the patent application for the foveal shape analysis method (“Method for estimating shape parameters of the fovea byoptical coherence tomography,” International PublicationNumber: “WO 2019/016319 A1”), is a cofounder and hold shares in technology start-up Nocturne GmbH, receives honoraria for lecturing, and travel expenses for attending meetings from Guthy Jackson Foundation, Bayer, Biogen, Merck Serono, Sanofi-Genzyme, Novartis, Alexion, Viela Bio, Roche, UCB, Mitsubishi Tanabe and Celgene. His research is funded by the German Ministry for Education and Research (BMBF), Deutsche Forschungsgemeinschaft (DFG), Einstein Foundation, Guthy Jackson Charitable Foundation, EU FP7 Framework Program, Biogen, Genzyme, Merck Serono, Novartis, Bayer, Alexion, Roche, Parexel and Almirall. C. Chien received honoraria for lecturing from Bayer, and research funding from Novartis. J. Oh reports grants from MS Society of Canada, Barford and Love MS Fund of St. Michael’s Hospital Foundation, National MS Society, Brain Canada, Biogen-Idec, Roche, and EMD-Serono; and personal fees for consulting or speaking from Biogen-Idec, EMD-Serono, Roche, Sanofi-Genzyme, Novartis, Alexion, and BMS. D. Rotstein has received research support from the MS Society of Canada, Consortium of Multiple Sclerosis Centers, and Roche Canada. She has served as a speaker or consultant for Alexion, Biogen, EMD-Serono, Novartis, Roche and Sanofi Aventis.

Figures

Figure 1.
Figure 1.
The use of magnetic resonance imaging (MRI) for three key phases during the disease course of neuromyelitis optica spectrum disorder (NMOSD): diagnosis, prognostication, and disease monitoring.
Figure 2.
Figure 2.
Imaging characteristics of spinal cord lesions in AQP4+ NMOSD and MOG+ myelitis. (a) AQP4-IgG+ disease, sagittal T2 sequences: longitudinally extensive lesions, extension of cervical cord lesions rostrally into the dorsal medulla, and subsequent cord atrophy and discontinuity of lesions in chronic LETM. (b) MOG-IgG+ disease, sagittal and axial T2 sequences: short-segment spinal cord lesions as demonstrated, LETM may also occur. (c) MOG-IgG+ disease, sagittal T2 and sagittal and axial T1 gadolinium-enhanced sequences: although bright spotty lesions are more frequently associated with AQP4-IgG+ NMOSD, they may rarely occur with other causes of transverse myelitis, as seen here. The short length and peripheral location of this lesion, in addition to serologic testing, helped to confirm the diagnosis of MOG-IgG+ disease. LETM, longitudinally extensive transverse myelitis; AQP4, aquaporin-4; MOG, myelin oligodendrocyte glycoprotein.
See this image and copyright information in PMC

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