Persistently Gadolinium-Enhancing Lesion Is a Predictor of Poor Prognosis in NMOSD Attack: a Clinical Trial

Abstract

Gadolinium (Gd)-contrast MRI for reliable detection of blood-brain barrier (BBB) breakdown is widely used in neuromyelitis optica spectrum disorder (NMOSD) attack. Nonetheless, little is known about the predictive role of gadolinium-enhancing lesion in prognosis of NMOSD attack. The aim of this work is to investigate the predictive value of persistently Gd-enhanced lesions to medium-term outcome after attack. Data for this analysis came from an ongoing prospective cohort study (CLUE). NMOSD patients with acute attack were enrolled from January 2019 to March 2020. All patients underwent Gd-contrast MRI at baseline and 1 month, and disability was assessed by Expanded Disability Status Scale (EDSS). Primary outcome was EDSS improvement from baseline to month 6. Multiple logistic regression identified predictors for poor recovery of NMOSD attack. Forty-one participants were analyzed, of which 21 patients had persistently Gd-enhancing lesions. Patients in no enhancement (NE) group showed a significant shift in 6-month EDSS distributions compared with those in persistent enhancement (PE) group (p = 0.005). Poor recovery rate of the PE group was higher than that of the NE group at 6 months (p = 0.033). In patients with aquaporin-4-positive, first-attack, transverse myelitis or in a high-dose steroid treatment subgroup, the improvement of EDSS scores in the PE group was still less compared with that in the NE group (p < 0.05). The presence of persistently Gd-enhancing lesion appears to be associated with poor recovery after attack (OR = 5.473, p = 0.014). Our study found that persistently gadolinium-enhancing lesion is a poor prognosis predictor after NMOSD attack. Trial registration ID: NCT04106830.

Keywords: MRI; NMOSD; acute attack; clinical trial; prognosis.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The American Society for Experimental NeuroTherapeutics, Inc.

Figures

Fig. 1

Trial profile of the post-contrast MRI scan trial. Gd+ = gadolinium positive; EDSS = Expanded Disability Status Scale; CNS = central nervous system; PE = persistent enhancement; NE = no enhancement.

Fig. 2

Representative gadolinium enhancement MRI images of NMOSD patients. (A) Patchy gadolinium-enhanced lesion was found in C1–3 and persistently existed after 1 month. (B) Open-ring enhanced lesion in C1–3 disappeared at 1-month follow up.

Fig. 3

The changes of EDSS score in the PE and NE groups after follow-up. (A) Distribution of Expanded Disability Status Scale (EDSS) scores at attack, at 1 month and 6 months in both groups. (B) The improvement of EDSS score in the persistent enhancement group was worse than that in the no enhancement group at 6 months. p′ = adjusted p value.

Fig. 4

Comparison of EDSS score changes in patients with AQP4-IgG positive, first attack, LETM, and IVMP treatment. (A) Median EDSS score of the NE group was lower in AQP4-IgG-positive patients at 6 month (n = 33). (B) EDSS improvement in the PE group was less than that in the NE group in patients who experienced first attack (n = 25). (C) In patients with transverse myelitis, EDSS improved poorly in the PE group compared with the NE group (n = 30). (D) In patients treated only with IVMP, 6-month median EDSS score was lower in the NE group (n = 33). *p < 0.05 and **p < 0.01.