Highlights
- •Longitudinal multiparametric 7T MRI may help us in understanding the pathophysiologic processes that drive NMOSD disease.
- •Cerebral lesions in NMOSD are non-associated with iron pathology.
- •No appreciable change in lesion size and lesion-vessel relationship is seen during a course of 2-3-year follow-up period.
- •Asymptomatic cerebral NMOSD lesions, once formed, tend to remain relatively inert.
- •No significant change in brain volume is observed during a short follow-up period.
Abstract
Background
In neuromyelitis optica spectrum disorder (NMOSD), clinical disability in NMOSD patients
is relapse-related and progressive phase is rare. This observation raises the question
whether there is any radiographic disease activity. The aim of present study was to
determine the longitudinal changes in cerebral lesion number, lesion size, lesion-to-venule
relationship, and morphological patterns of lesions in NMOSD using multiparametric
7T MR imaging. We also aimed to assess brain volume changes in NMOSD.
Methods
A cohort of 22 patients with NMOSD underwent high-resolution 3D-susceptibility weighted
imaging (SWI) and 2D-gradient-echo (GRE-T2*) weighted imaging on 7T MRI of brain at
baseline and after ~2.8 years of follow-up. Morphologic imaging characteristics, and
signal intensity patterns of lesions were recorded at both time points. Lesions were
classified as "iron-laden" if they demonstrated hypointense signal on GRE-T2* images
and/or SWI as well as hyperintense signal on quantitative susceptibility mapping (QSM).
Lesions were considered "non-iron-laden" if they were hyperintense on GRE-T2*/SWI
and isointense or hyperintense on QSM. Additionally, fractional brain parenchymal
volume (fBPV) was computed at both time points.
Results
A total of 169 lesions were observed at baseline. At follow-up, 6 new lesions were
found in 5 patients. In one patient, a single lesion could not be detected on the
follow-up scan. No appreciable change in lesion size and vessel-lesion relationship
was observed at follow up. All lesions demonstrated hyperintense signal intensity
on GRE-T2* weighted images and isointense signal on QSM at both time points. Therefore,
these lesions were considered as non-associated with iron pathology. Additionally,
no significant change in brain volume was observed: fBPV 0.78 ± 0.06 at baseline vs.
0.77 ± 0.05 at follow up, p>0.05.
Conclusion
Cerebral lesions in NMOSD patients remain ‘inert’ and do not show any substantial
variations in morphological characteristics during a 2–3-year follow-up period.
Keywords
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Article info
Publication history
Published online: March 25, 2020
Accepted:
March 20,
2020
Received in revised form:
February 19,
2020
Received:
December 4,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
