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Magnetic resonance imaging at baseline and follow-up to differentiate between pediatric monophasic acquired CNS demyelination and MS

Published:October 21, 2020DOI:https://doi.org/10.1016/j.msard.2020.102590

      Highlights

      • At baseline 60% of ADEM children fulfilled dissemination in space.
      • On baseline MRI, McDonald criteria were fulfilled in 17% ADEM and 34% MS children.
      • On follow-up MRI, McDonald criteria were fulfilled in 4% ADEM and 65% MS children.
      • Only 42% of ADEM children had complete lesion resolution on follow-up MRI.
      • Rarity of MS in first decade of life should be considered when interpreting MRI.

      Abstract

      Background

      It is essential to distinguish acute disseminated encephalomyelitis (ADEM) from MS early. Our aim was to determine MRI features at baseline and follow-up to distinguish pediatric ADEM from MS stratified according to age at onset.

      Methods

      Using hospital ICD-10 codes for acquired demyelinating syndromes from a nationwide register and subsequent chart review, we identified 52 children (<18 years) with ADEM and 66 children with MS. We undertook a retrospective analysis of MRI scans at onset and at follow-up. The MRI rater was a senior neuroradiologist blinded to clinical characteristics.

      Results

      At baseline, children with ADEM had more diffuse poorly demarcated lesions, particularly in the basal ganglia/thalamus (p = 0.001) and cerebellar peduncles (p < 0.0001). Further, longitudinal extensive transverse myelitis was strongly associated with ADEM (p<0.0001). Children with ADEM had fewer contrast-enhancing lesions (p = 0.0004), occipital lesions (p = 0.01), optic nerve lesions (p = 0.01), periventricular lesions, well-defined lesions only (p<0.0001), and fewer fulfilled dissemination in time according to the McDonald 2017 criteria (p = 0.005). On baseline MRI, dissemination in space and time was fulfilled in 17% of children with ADEM and in 34% of children with MS (p = 0.06), and 60% of children with ADEM fulfilled the criterion for dissemination in space. The mean time from baseline MRI to follow-up MRI was 1.0 year for children with ADEM and 2.1 years for children with MS. On follow-up MRI, 85% of children with ADEM had partial or complete T2 lesion resolution, but in the 58% without complete resolution lesions were predominantly frontal. Only 47% of children with MS had partial or complete T2 lesion resolution, and therefore more MRI features differed between children with ADEM and MS on follow-up. MRI had the greatest distinguishing value after age 11 years because MS is exceptional in the first decade of life.

      Conclusion

      Age at onset and the timing of MRI in relation to disease onset are critical in the interpretation of MRI to distinguish between ADEM and MS.

      Keywords

      Abbreviations:

      : ADEM (acute disseminated encephalomyelitis), ADS (acquired demyelinating syndrome), ICD-10 (International Classification of Diseases version 10), IPMSSG (International Pediatric MS Study Group), MOG (myelin oligodendrocyte glycoprotein), MS (multiple sclerosis)
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      References

        • Krupp LB
        • Tardieu M
        • Amato MP
        • Banwell B
        • Chitnis T
        • Dale RC
        • et al.
        International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions.
        Mult. Scler. 2013; 19 (Sep): 1261-1267
        • Boesen MS
        • Magyari M
        • Koch-Henriksen N
        • Uldall PV
        • Thygesen LC
        • Blinkenberg M
        • et al.
        Implications of the International Paediatric Multiple Sclerosis Study Group consensus criteria for paediatric acute disseminated encephalomyelitis: a nationwide validation study.
        Dev. Med. Child Neurol. 2018; 60 (Nov 1): 1123-1131
        • Boesen MS
        • Magyari M
        • Koch-Henriksen N
        • Thygesen LC
        • Born AP
        • Uldall PV
        • et al.
        Pediatric-onset multiple sclerosis and other acquired demyelinating syndromes of the central nervous system in Denmark during 1977–2015: a nationwide population-based incidence study.
        Mult. Scler. J. 2018 Jul; 24: 1077-1086
        • Hennes E-M
        • Baumann M
        • Schanda K
        • Anlar B
        • Bajer-Kornek B
        • Blaschek A
        • et al.
        Prognostic relevance of MOG antibodies in children with an acquired demyelinating syndrome.
        Neurology. 2017 Aug 29; 89: 900-908
        • Boesen MS
        • Jensen PEH
        • Born AP
        • Magyari M
        • Nilsson AC
        • Hoei-Hansen C
        • et al.
        Incidence of pediatric neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease in Denmark 2008‒2018: a nationwide, population-based cohort study.
        Mult. Scler. Relat. Disord. 2019 Aug; 33: 162-167
        • Thompson AJ
        • Banwell BL
        • Barkhof F
        • Carroll WM
        • Coetzee T
        • Comi G
        • et al.
        Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.
        Lancet Neurol. 2018; 17 (Feb): 162-173
        • Polman CH
        • Reingold SC
        • Banwell B
        • Clanet M
        • Cohen JA
        • Filippi M
        al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria..
        Ann. Neurol. 2011; 69 (Feb 1): 292-302
        • Callen DJA
        • Shroff MM
        • Branson HM
        • Li DK
        • Lotze T
        • Stephens D
        • et al.
        Role of MRI in the differentiation of ADEM from MS in children.
        Neurology. 2009; 72 (Mar 17): 968-973
        • Ketelslegers IA
        • Neuteboom RF
        • Boon M
        • Catsman-Berrevoets CE
        • Hintzen RQ
        Dutch pediatric MS study group. A comparison of MRI criteria for diagnosing pediatric ADEM and MS.
        Neurology. 2010; 74 (May 4): 1412-1415
        • Mikaeloff Y
        • Adamsbaum C
        • Husson B
        • Vallée L
        • Ponsot G
        • Confavreux C
        • et al.
        MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood.
        Brain J. Neurol. 2004 Sep; 127: 1942-1947
        • Lynge E
        • Sandegaard JL
        • Rebolj M
        The Danish National Patient Register.
        Scand. J. Public Health. 2011; 39 (Jul): 30-33
        • Boesen MS
        • Magyari M
        • Born AP
        • Thygesen LC
        Pediatric acquired demyelinating syndromes: a nationwide validation study of the Danish National Patient Register.
        Clin. Epidemiol. 2018; 2018: 391-399
        • Boesen MS
        • Langkilde A
        • Born AP
        • Magyari M
        • Blinkenberg M
        • Chitnis T
        • et al.
        School performance and psychiatric morbidity 6 years after pediatric acute disseminated encephalomyelitis: a nationwide population-based cohort study.
        Mult. Scler. Relat. Disord. 2019 Nov; 36101425
        • Barkhof F
        • Filippi M
        • Miller DH
        • Scheltens P
        • Campi A
        • Polman CH
        • et al.
        Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis.
        Brain J. Neurol. 1997 Nov; 120: 2059-2069
        • Kanda T
        • Ishii K
        • Kawaguchi H
        • Kitajima K
        • Takenaka D
        High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material.
        Radiology. 2014; 270 (Mar): 834-841
      1. Lov om ændring af lov om retshåndhævende myndigheders behandling af personoplysninger, lov om massemediers informationsdatabaser og forskellige andre love [Internet]. LOV nr 503 May 23, 2018. Available from: https://www.retsinformation.dk/Forms/R0710.aspx?id=201317.

        • Boesen MS
        • Sellebjerg F
        • Blinkenberg M
        Onset symptoms in paediatric multiple sclerosis.
        Dan. Med. J. 2014 Apr; 61: A4800