TY - JOUR
T1 - Utility of MRI Enhancement Pattern in Myelopathies With Longitudinally Extensive T2 Lesions
AU - Mustafa, Rafid
AU - Passe, Theodore J.
AU - Lopez-Chiriboga, Alfonso S.
AU - Weinshenker, Brian G.
AU - Krecke, Karl N.
AU - Zalewski, Nicholas L.
AU - Diehn, Felix E.
AU - Sechi, Elia
AU - Mandrekar, Jay
AU - Kaufmann, Timothy J.
AU - Morris, Padraig P.
AU - Pittock, Sean J.
AU - Toledano, Michel
AU - Lanzino, Giuseppe
AU - Aksamit, Allen J.
AU - Kumar, Neeraj
AU - Lucchinetti, Claudia F.
AU - Flanagan, Eoin P.
N1 - Funding Information:
Dr. Mustafa, Dr. Passe, and Dr. Lopez-Chiriboga report no disclosures. Dr. Weinshenker receives royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for neuromyelitis optica spectrum disorders, served on adjudication committee for clinical trials in neuromyelitis optica spectrum disorders being conducted by MedImmune and Alexion, and consulted for Chugai/Roche/Genentech and Mitsubishi-Tanabe regarding a clinical trial for neuromyelitis optica spectrum disorders. Dr. Krecke, Dr. Zalewski, Dr. Diehn, and Dr. Sechi report no disclosures. Dr. Mandrekar and Dr. Kaufmann report no disclosures relevant to this study. Dr. Morris reports no disclosures. Dr. Pittock reports grants, personal fees, and nonfinancial support from Alexion Pharmaceuticals, Inc.; grants from Grifols and Autoimmune Encephalitis Alliance; and grants, personal fees, nonfinancial support, and other from MedImmune, Inc.; Dr. Pittock has a patent # 9,891,219 (Application #12–573942) “Methods for treating neuromyelitis optica (NMO) by administration of eculizumab to an individual that is aquaporin-4 (AQP4)-IgG autoantibody positive”. Dr Pittock also has patents pending for the following IgGs as biomarkers of autoimmune neurologic disorders (septin-5, Kelch-like protein 11, GFAP, PDE10A, and MAP1B). Dr. Toledano reports no disclosures. Dr. Lanzino is a consultant for Superior Medical Editing and Nested Knowledge. Dr. Aksamit and Dr. Kumar report no disclosures. Dr. Lucchinetti reports no disclosures relevant to this study. Dr. Flanagan is a site principal investigator in a randomized placebo-controlled clinical trial of Inebilizumab (A CD19 inhibitor) in neuromyelitis optica spectrum disorders funded by MedImmune/Viela Bio. He receives no personal compensation and just receives reimbursement for the research activities related to the trial. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp .
Publisher Copyright:
© 2022 American Academy of Neurology.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - ObjectiveTo determine whether MRI gadolinium enhancement patterns in myelopathies with longitudinally extensive T2 lesions can be reliably distinguished and assist in diagnosis.MethodsWe retrospectively identified 74 Mayo Clinic patients (January 1, 1996-December 31, 2019) fulfilling the following criteria: (1) clinical myelopathy; (2) MRI spine available; (3) longitudinally extensive T2 hyperintensity (≥3 vertebral segments); and (4) characteristic gadolinium enhancement pattern associated with a specific myelopathy etiology. Thirty-nine cases with alternative myelopathy etiologies, without previously described enhancement patterns, were included as controls. Two independent readers, educated on enhancement patterns, reviewed T2-weighted and postgadolinium T1-weighted images and selected the diagnosis based on this knowledge. These were compared with the true diagnoses, and agreement was measured with Kappa coefficient.ResultsAmong all cases and controls (n = 113), there was excellent agreement for diagnosis using postgadolinium images (kappa, 0.76) but poor agreement with T2-weighted characteristics alone (kappa, 0.25). A correct diagnosis was more likely when assessing postgadolinium image characteristics than with T2-weighted images alone (rater 1: 100/113 [88%] vs 61/113 [54%] correct, p < 0.0001; rater 2: 95/113 [84%] vs 68/113 [60%] correct, p < 0.0001). Of the 74 with characteristic enhancement patterns, 55 (74%) were assigned an alternative incorrect or nonspecific diagnosis when originally evaluated in clinical practice, 12 (16%) received immunotherapy for noninflammatory myelopathies, and 2 (3%) underwent unnecessary spinal cord biopsy.ConclusionsMisdiagnosis of myelopathies is common. The gadolinium enhancement patterns characteristic of specific diagnoses can be identified with excellent agreement between raters educated on this topic. This study highlights the potential diagnostic utility of enhancement patterns in myelopathies with longitudinally extensive T2 lesions.
AB - ObjectiveTo determine whether MRI gadolinium enhancement patterns in myelopathies with longitudinally extensive T2 lesions can be reliably distinguished and assist in diagnosis.MethodsWe retrospectively identified 74 Mayo Clinic patients (January 1, 1996-December 31, 2019) fulfilling the following criteria: (1) clinical myelopathy; (2) MRI spine available; (3) longitudinally extensive T2 hyperintensity (≥3 vertebral segments); and (4) characteristic gadolinium enhancement pattern associated with a specific myelopathy etiology. Thirty-nine cases with alternative myelopathy etiologies, without previously described enhancement patterns, were included as controls. Two independent readers, educated on enhancement patterns, reviewed T2-weighted and postgadolinium T1-weighted images and selected the diagnosis based on this knowledge. These were compared with the true diagnoses, and agreement was measured with Kappa coefficient.ResultsAmong all cases and controls (n = 113), there was excellent agreement for diagnosis using postgadolinium images (kappa, 0.76) but poor agreement with T2-weighted characteristics alone (kappa, 0.25). A correct diagnosis was more likely when assessing postgadolinium image characteristics than with T2-weighted images alone (rater 1: 100/113 [88%] vs 61/113 [54%] correct, p < 0.0001; rater 2: 95/113 [84%] vs 68/113 [60%] correct, p < 0.0001). Of the 74 with characteristic enhancement patterns, 55 (74%) were assigned an alternative incorrect or nonspecific diagnosis when originally evaluated in clinical practice, 12 (16%) received immunotherapy for noninflammatory myelopathies, and 2 (3%) underwent unnecessary spinal cord biopsy.ConclusionsMisdiagnosis of myelopathies is common. The gadolinium enhancement patterns characteristic of specific diagnoses can be identified with excellent agreement between raters educated on this topic. This study highlights the potential diagnostic utility of enhancement patterns in myelopathies with longitudinally extensive T2 lesions.
UR - http://www.scopus.com/inward/record.url?scp=85117262894&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117262894&partnerID=8YFLogxK
U2 - 10.1212/CPJ.0000000000001036
DO - 10.1212/CPJ.0000000000001036
M3 - Article
AN - SCOPUS:85117262894
SN - 2163-0402
VL - 11
SP - E601-E611
JO - Neurology: Clinical Practice
JF - Neurology: Clinical Practice
IS - 5
ER -