Abstract Details

Title MR T2-Relaxation Time as an Indirect Measure of Brain Water Content and Disease Activity in Neuromyelitis Optica Spectrum Disorders

Topic Multiple Sclerosis

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

Poster/Presentation
Number 152

Objective To provide an indirect estimation of brain water content in Neuromyelitis Optica Spectrim Disorders (NMOSD) by measuring T2-relaxation time (T2rt) and to assess whether it differs in patients having a short-term relapse.

Background

An unmet need in the management of NMOSD is having a marker predicting short-term relapses. In physiological conditions, aquaporin-4 (AQP4) water channel on astrocytes is the main regulator of CNS water influx and efflux. In NMOSD, auto-antibodies target this channel and trigger complement-mediated astrocytes damage, possibly leading to water leakage across the blood-brain barrier. Accordingly, increased T2-signal in acute lesions (“bright spotty lesions”) is considered specific for NMOSD.

Design/Methods In this multicenter MR study, T2rt was calculated from brain dual echo turbo spin echo images assuming a mono exponential decay. T2rt maps of normal appearing white matter (NAWM), gray matter (GM) and basal ganglia were obtained from 77 AQP4-positive NMOSD and 84 HC. Short-term relapses were defined as those occurring within one month before or after MRI scan. Differences between NMOSD and HC were assessed with age-, sex- and site-adjusted linear models. ROC analyses were run to identify discriminators between stable and short-term relapsing patients.

Results NMOSD patients and HC had similar ages. Compared to HC, T2rt was increased in the GM (103 vs 97 ms), NAWM (88 vs 84 ms) and putamen (75 vs 72 ms) of NMOSD patients (p<0.001 for all). Short-term relapses occurred in 20/77 (26%) of patients. T2rt cut-offs of 87 ms (NAWM), 87 ms (thalamus) and 88 ms (caudatum) were able to discriminate between short-term relapsing and stable patients with good accuracy (AUC=0.70, 0.76 and 0.79 respectively, p≤ 0.027).

Conclusions

NMOSD patients had increased T2rt values, suggesting a subclinical water accumulation in this disorder. The burden of T2rt alterations might be useful for identifying those patients with incipient or recent relapses.

Authors/Disclosures
Laura Cacciaguerra, MD, PhD (Mayo Clinic) PRESENTER	Dr. Cacciaguerra has nothing to disclose.
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.
Elisabetta Pagani	Elisabetta Pagani 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.
Vittorio Martinelli (S. Raffaele Hospital)	Dr. Martinelli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis, Biogen, Sanofi Genzyme, TEVA and Merck. Dr. Martinelli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck .
	No disclosure on file
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.

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