Abstract Details

Title Anterior Horn T2-Hyperintensity: A Novel Outcome Measure in Acute Flaccid Myelitis

Topic Child Neurology and Developmental Neurology

Presentation(s) S38 - Child Neurology and Developmental Neurology: Acquired Brain Injury: Brain-Behavior Relationships (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

Objective To assess whether MR imaging can predict outcomes in acute flaccid myelitis (AFM).

Background AFM is an emerging polio-like illness primarily affecting children. There is an urgent need for biomarkers to predict outcomes in AFM.

Design/Methods We identified patients with AFM treated at our institutions from 2014-2018 who completed spinal MRI during the convalescent phase. We developed a novel 4-point scale to rate T2-signal intensity in each anterior horn at each vertebral level, ranging from normal T2-signal to marked T2-hyperintensity. In each subject, these scores were summed to determine a global anterior horn T2-hyperintensity (AHH) score and limb-specific AHH scores (derived from the right or left anterior horns of the cervical or lumbar enlargements). Outcome at latest clinical follow-up was recorded using the medical research council (MRC)-sum score at a global level (0 [complete tetraplegia] to 60 [normal]) and a limb-specific level (0 to 15). Associations were analyzed using Spearman’s correlation, linear and logistic regression.

Results We included 20 patients with a median age of 4.3 years. After onset of neurological symptoms, median time to convalescent MRI was 64 days and median time to latest clinical follow-up was 174 days. Median global MRC-sum score was 19 (IQR=10 to 44) at clinical nadir, and improved to 33 (IQR=18 to 50) at follow-up. In individuals, higher global AHH score predicted worse outcome measured by the global MRC-sum score at follow-up (p=0.008, R=0.58). Similarly, higher limb-specific AHH score predicted worse limb-specific MRC-sum score (p<0.001, R=0.57). Furthermore, summed AHH score between C3 and C5 (segments providing diaphragmatic innervation) predicted long-term ventilation dependence (p=0.001).

Conclusions In patients recovering from AFM, the degree and extent of T2-signal abnormality in the anterior horns appears to be an in-vivo marker of neuronal destruction. Our novel MRI scoring tool can aid prognostication and inform decisions about potential interventions such as nerve transfer surgery.

Authors/Disclosures
Olwen Murphy, MD (Johns Hopkins Hospital) PRESENTER	Dr. Murphy has nothing to disclose.
Ruth Andrea Salazar Camelo, MD (Johns Hopkins School of Medicine)	Dr. Salazar Camelo has nothing to disclose.
	No disclosure on file
	No disclosure on file
Carlos A. Pardo-Villamizar, MD (Johns Hopkins U, Med Dept of Neurology)	The institution of Dr. Pardo-Villamizar has received research support from National Institutes of Health. The institution of Dr. Pardo-Villamizar has received research support from Bart McLean Fund for Neuroimmunology Research .

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