Abstract Details

Title Application of Deep-Learning to NMOSD and Seronegative Patients with Limited NMOSD Manifestations

Topic Multiple Sclerosis

Presentation(s) MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 158

Objective

To provide a deep learning classification of neuromyelitis optica spectrum disorders (NMOSD) patients with different phenotypes and of unclassified seronegative patients with limited NMOSD manifestations.

Background

The inclusion of seronegative patients within the spectrum of NMO is debated. Patients with limited NMOSD manifestations remain unclassified and are considered prodromal phases of multiple sclerosis (MS).

Design/Methods 228 T2- and T1-weighted brain MRIs were acquired from aquaporin-4-seropositive NMOSD (n=85), MS (n=95), aquaporin-4-seronegative NMOSD (n=11, three with anti-myelin oligodendrocyte glycoprotein antibodies [MOG]) and unclassified seronegative patients with limited NMOSD manifestations (n=37, of whom 17 idiopathic recurrent optic neuritis and 20 idiopathic recurrent myelitis). The latter had a clinical re-evaluation after a median follow-up of four years. The neural network architecture was based on four 3D convolutional layers. It was trained and validated on MRI scans from aquaporin-4-seropositive NMOSD and MS patients (n=180). Then, it was applied to aquaporin-4-seronegative NMOSD and unclassified seronegative patients to evaluate if automated classification identified these patients as belonging to the NMOSD or MS group. Assignment of unclassified seronegative patients with limited NMOSD manifestations was compared with their clinical follow-up.

Results

The final algorithm differentiated aquaporin-4-seropositive NMOSD and MS patients with an accuracy of 0.95. All aquaporin-4-seronegative NMOSD and 36/37 seronegative unclassified patients were classified as NMOSD. Anti-MOG NMOSD patients were classified as NMOSD, but with a probability similar to that of being MS. Clinical follow-up was available in 73% unclassified seronegative patients: one evolved to MS, three developed NMOSD and the others did not change phenotype.

Conclusions

Deep-learning may help in the diagnostic work-up of NMOSD. Our findings support the inclusion of aquaporin4-seronegative patients into the NMO spectrum (with uncertainty regarding anti-MOG) and suggest its expansion to seronegative unclassified patients with limited NMOSD manifestations.

Authors/Disclosures
Laura Cacciaguerra, MD, PhD (Mayo Clinic) PRESENTER	Dr. Cacciaguerra has nothing to disclose.
Loredana Storelli	Loredana Storelli has nothing to disclose.
Marta Radaelli (Hsr)	Marta Radaelli has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono. Marta Radaelli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Marta Radaelli has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Marta Radaelli has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Sanofi-Genzyme.
Sarlota Mesaros	Sarlota Mesaros has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Sarlota Mesaros has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca. Sarlota Mesaros has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Novartis. Sarlota Mesaros has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Hemofarm. Sarlota Mesaros has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
Lucia Moiola, MD, PhD (Fondazione Centro San Raffaele)	Dr. Moiola has nothing to disclose.
Jelena Drulovic	Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck . Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Hemofarm. Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PharmaSwiss. Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck . Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Actavis TEVA. Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Hemofarm. Jelena Drulovic has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medis. Jelena Drulovic has received research support from Ministry of Science, Technological Development and Innovations of the Republic of Serbia.
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.
Maria A. Rocca (Neuroimaging Research Unit)	Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche. Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. The institution of Maria Assunta Rocca has received research support from MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.

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