Contributions
Abstract: P825
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: Early differentiation of pediatric NMO from other childhood demyelinating disorders including multiple sclerosis and acute disseminated encephalomyelitis (ADEM) is critical for instituting appropriate therapy.
Goal: The goal of this study was to characterize and explore differential MRI features in pediatric patients with NMO spectrum disorders relative to MS and ADEM.
Methods: Brain and spine MRIs were collected from pediatric NMO patients (age at onset< 18years) identified from 9 U.S. Network of Pediatric MS Centers (NPMSC). MRIs from matched pediatric MS and ADEM were analyzed for comparison (clinical validations in Neurology 2016; 86(3):245-52). MRI lesion analysis was performed by a single evaluator blinded to the clinical diagnosis of cases, using a web-based “virtual laboratory” (https://spinevirtuallab.org). Each lesion visualized on brain MRI FLAIR and T2 SE sequence, was annotated for: Lesion signal, shape, location, gadolinium enhancement, border, size. Spine MRI lesions were categorized according to the following criteria: lesion location level, length, gadolinium enhancement.
Results: 19 NMO, 28 MS and 19 ADEM patients had baseline brain MRI scan, and 9, 13 and 7 from these respective groups had baseline cervical-thoracic MRIs. Longitudinally extensive transverse myelitis (LETM), defined as ≥3 spinal cord segments were not differentially present in the three groups (56% NMO, 42% RRMS and 71% ADEM) Chi-squared test, p-value=0.450. Optic nerve structures were not differentially involved between groups, Chi-squared test, p-value=0.090. 29% of NMO, 76% of RRMS, and 79% of ADEM patients met the McDonald 2010 criteria for dissemination in space on their first MRI. The presence of a juxtacortical or a subcortical lesion differentiated pediatric MS (83%) from pediatric NMO (14%), Chi-squared test, p< 0.001. Other areas that were differentially affected between NMO and MS patients on initial brain MRI were corpus callosum (61% MS, 16% NMO), and the cerebellar white matter (29% MS, 0% NMO).
Conclusions: LETM was not differentially present in pediatric NMO versus MS, however cerebral lesion location features differed between groups. These findings may inform the development of diagnostic criteria distinguishing between early forms of pediatric NMO and MS.
Disclosure: This work was funded by the Guthy Jackson Charitable Foundation (TC-Eureka grant).
Roxana Ameli: nothing to disclose
Juan Carlos Prieto: nothing to disclose
Michael Waltz: nothing to disclose
Jan Tillema: nothing to disclose
Jennifer Graves: nothing to disclose
Bianca Weinstock: nothing to disclose
Anita Belman: nothing to disclose
Cody Olsen: nothing to disclose
Gregory Aaen: nothing to disclose
Leslie Benson: nothing to disclose
Mark Gorman: nothing to disclose
Lauren Krupp: nothing to disclose
Timothy Lotze: nothing to disclose
Jayne Ness: nothing to disclose
Emmanuelle Waubant: nothing to disclose
John Rose: nothing to disclose
Moses Rodriguez: nothing to disclose
Charlie Casper: nothing to disclose
Otto Rapalino: nothing to disclose
François Cotton: nothing to disclose
Charles Guttmann: nothing to disclose
Tanuja Chitnis: nothing to disclose
Abstract: P825
Type: Poster
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: Early differentiation of pediatric NMO from other childhood demyelinating disorders including multiple sclerosis and acute disseminated encephalomyelitis (ADEM) is critical for instituting appropriate therapy.
Goal: The goal of this study was to characterize and explore differential MRI features in pediatric patients with NMO spectrum disorders relative to MS and ADEM.
Methods: Brain and spine MRIs were collected from pediatric NMO patients (age at onset< 18years) identified from 9 U.S. Network of Pediatric MS Centers (NPMSC). MRIs from matched pediatric MS and ADEM were analyzed for comparison (clinical validations in Neurology 2016; 86(3):245-52). MRI lesion analysis was performed by a single evaluator blinded to the clinical diagnosis of cases, using a web-based “virtual laboratory” (https://spinevirtuallab.org). Each lesion visualized on brain MRI FLAIR and T2 SE sequence, was annotated for: Lesion signal, shape, location, gadolinium enhancement, border, size. Spine MRI lesions were categorized according to the following criteria: lesion location level, length, gadolinium enhancement.
Results: 19 NMO, 28 MS and 19 ADEM patients had baseline brain MRI scan, and 9, 13 and 7 from these respective groups had baseline cervical-thoracic MRIs. Longitudinally extensive transverse myelitis (LETM), defined as ≥3 spinal cord segments were not differentially present in the three groups (56% NMO, 42% RRMS and 71% ADEM) Chi-squared test, p-value=0.450. Optic nerve structures were not differentially involved between groups, Chi-squared test, p-value=0.090. 29% of NMO, 76% of RRMS, and 79% of ADEM patients met the McDonald 2010 criteria for dissemination in space on their first MRI. The presence of a juxtacortical or a subcortical lesion differentiated pediatric MS (83%) from pediatric NMO (14%), Chi-squared test, p< 0.001. Other areas that were differentially affected between NMO and MS patients on initial brain MRI were corpus callosum (61% MS, 16% NMO), and the cerebellar white matter (29% MS, 0% NMO).
Conclusions: LETM was not differentially present in pediatric NMO versus MS, however cerebral lesion location features differed between groups. These findings may inform the development of diagnostic criteria distinguishing between early forms of pediatric NMO and MS.
Disclosure: This work was funded by the Guthy Jackson Charitable Foundation (TC-Eureka grant).
Roxana Ameli: nothing to disclose
Juan Carlos Prieto: nothing to disclose
Michael Waltz: nothing to disclose
Jan Tillema: nothing to disclose
Jennifer Graves: nothing to disclose
Bianca Weinstock: nothing to disclose
Anita Belman: nothing to disclose
Cody Olsen: nothing to disclose
Gregory Aaen: nothing to disclose
Leslie Benson: nothing to disclose
Mark Gorman: nothing to disclose
Lauren Krupp: nothing to disclose
Timothy Lotze: nothing to disclose
Jayne Ness: nothing to disclose
Emmanuelle Waubant: nothing to disclose
John Rose: nothing to disclose
Moses Rodriguez: nothing to disclose
Charlie Casper: nothing to disclose
Otto Rapalino: nothing to disclose
François Cotton: nothing to disclose
Charles Guttmann: nothing to disclose
Tanuja Chitnis: nothing to disclose