Carnero Contentti Edgar, Delgado-García Guillermo, López Pablo A, Criniti Juan, Pettinicchi Juan Pablo, Correa-Díaz Edgar Patricio, Soto de Castillo Ibis, Daccach Marques Vanessa, Tkachuk Verónica, Cristiano Edgardo, Serva Braga Diéguez Gabriel, Dos Santos Antonio Carlos, Castillo María C, Patrucco Liliana, Álvarez Pucha Marcelo Oswaldo, Miño Zambrano Joselyn Elizabeth, Gómez-Figueroa Enrique, Rivas-Alonso Verónica, Flores-Rivera José, Caride Alejandro, Rojas Juan Ignacio
Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina.
Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud (PMDCMOS), Universidad Nacional Autónoma de México, Mexico City, Mexico.
Mult Scler Relat Disord. 2020 Nov;46:102558. doi: 10.1016/j.msard.2020.102558. Epub 2020 Oct 2.
Few studies regarding MRI-defined acute optic nerve lesions (aONL) in patients with first-ever neuromyelitis optica spectrum disorder (NMOSD)-related optic neuritis (ON) have been reported worldwide and none of them was conducted in Latin America (LATAM). Therefore, we aimed to assess the frequency of aONL at disease onset using conventional brain MRI in LATAM.
We reviewed the medical records and brain MRIs (≤30 days from ON onset) of patients with ON as first lifetime NMOSD attack. Patients from Argentina (n=48), Ecuador (n=24), Brazil (n=22), Venezuela (n=10) and Mexico (n=8) were included, and further divided into two subgroups according to either presence (P-MRI) or absence (A-MRI) of aONL (T2 hyperintensity and/or contrast enhancement). Clinical, paraclinical, imaging and prognostic data were compared.
A total of 112 patients were included and aONL were found in 86 (76.7%) at disease onset. Aquaporin-4 antibodies were detected in 69.6%. Non-Caucasian patients comprised 59.8% of the total cohort. In P-MRI, conventional brain MRI showed isolated or combined unilateral (54.4%, [8.5% of these aONL were associated with chiasmatic lesions]) and bilateral (46.6%, [35.9% of these aONL were associated with chiasmatic lesions]) lesions. Thus, 100% of chiasmatic lesions were associated with unilateral or bilateral lesions. No statistically significant differences were found in age, gender, ethnicity, clinical course, mean follow-up time, disability, and spinal cord MRI findings. However, rituximab use was higher in P-MRI than in A-MRI (p=0.006).
More than three quarters of LATAM patients with first-ever NMOSD-related ON have aONL detected by brain MRI. Unilateral lesions were the most common finding. Further studies including different ethnicities are needed to assess the generalizability of our results.
全球范围内，关于首次发作的视神经脊髓炎谱系障碍（NMOSD）相关视神经炎（ON）患者中磁共振成像（MRI）定义的急性视神经病变（aONL）的研究较少，且拉丁美洲（LATAM）尚未开展此类研究。因此，我们旨在利用传统脑部MRI评估拉丁美洲地区疾病发作时aONL的发生率。
我们回顾了首次发作的NMOSD相关ON患者的病历和脑部MRI（ON发作后≤30天）。纳入了来自阿根廷（n = 48）、厄瓜多尔（n = 24）、巴西（n = 22）、委内瑞拉（n = 10）和墨西哥（n = 8）的患者，并根据是否存在aONL（T2高信号和/或对比增强）进一步分为两个亚组。比较了临床、副临床、影像学和预后数据。
共纳入112例患者，其中86例（76.7%）在疾病发作时发现有aONL。69.6%的患者检测到水通道蛋白4抗体。非白种人患者占总队列的59.8%。在有aONL组（P-MRI）中，传统脑部MRI显示孤立或合并的单侧（54.4%，[其中8.5%的aONL与视交叉病变相关]）和双侧（46.6%，[其中35.9%的aONL与视交叉病变相关]）病变。因此，100%的视交叉病变与单侧或双侧病变相关。在年龄、性别、种族、临床病程、平均随访时间、残疾情况和脊髓MRI表现方面未发现统计学显著差异。然而，P-MRI组使用利妥昔单抗的比例高于无aONL组（A-MRI）（p = 0.006）。
超过四分之三的拉丁美洲首次发作NMOSD相关ON患者通过脑部MRI检测到aONL。单侧病变是最常见的发现。需要进一步纳入不同种族的研究来评估我们结果的普遍性。
