Abstract Details

Title MRI Patterns Distinguish Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis

Topic Multiple Sclerosis

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

Poster/Presentation
Number 163

Objective To develop an MRI based diagnostic algorithm to distinguish AQP4 positive neuromyelitis optica spectrum disorder (NMOSD) from multiple sclerosis (MS).

Background NMOSD (MS) are inflammatory diseases of the CNS that share clinical and MRI features making distinguishing these conditions difficult. We have conducted a cohort comparison analysis of imaging data. The results were used to develop predictive models for distinguishing NMOSD and MS.

Design/Methods A literature search to identify MRI lesions and features associated with NMOSD and define those lesions was undertaken. MS lesions were identified from published diagnostic criteria. Cases of AQP4 seropositive NMOSD were collected from across Australia and New Zealand using the 2015 International panel for NMO diagnosis criteria. Age and sex-matched MS cases were collected through the same centres. MRI were reported by at least two blinded reviewers. Relative frequencies of lesions were compared using odds ratios and predictive models were developed using scores and machine learning.

Results MRI brain or spine was available for 166/168 (99%) of NMOSD and MS cases. Lesions showing greatest association with NMOSD were lesions of the spinal cord that were longitudinally extensive (OR=203), “bright spotty” (OR 93.8), whole (axial; OR=57.8) or gadolinium (Gd) enhancing (OR=28.6), optic nerve lesions that were bilateral (OR=31.3) or Gd-enhancing (OR=15.4), and nucleus tractus solitarius (OR=19.2), periaqueductal (OR=16.8) or hypothalamic (OR7.2) brain lesions. Lesions with greatest association with MS were ovoid (OR=0.029), Dawson’s fingers (OR 0.031), basal corpus callosum (OR=0.058), periventricular (OR=0.136), temporal lobe (OR=0.137) and T1 black holes (OR0.154). A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone.

Conclusions We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 positive NMOSD or MS.

Authors/Disclosures
Laura Clarke, MBBS PRESENTER	Dr. Clarke has nothing to disclose.
	No disclosure on file
Wajih U. Bukhari, MD (Frankston Hospial)	Dr. Bukhari has nothing to disclose.
Elham Khalilidehkordi, MD (Queensland Health)	Dr. Khalilidehkordi has nothing to disclose.
	No disclosure on file
Cullen M. O'Gorman, MBBS (Queensland Health)	Dr. O'Gorman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen Australia Pty. An immediate family member of Dr. O'Gorman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Lundbeck Australia. An immediate family member of Dr. O'Gorman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Otsuka.
	No disclosure on file
Nadia M. Celestin, BS (Tisch MS Research Center of New York)	Miss Celestin has nothing to disclose.
	No disclosure on file
	No disclosure on file
David A. Abernethy, FRACP, MB, ChB	No disclosure on file
	No disclosure on file
Stefan Blum, PhD, FRACP (Princess Alexandra Hospital)	The institution of Dr. Blum has received research support from Merck. The institution of Dr. Blum has received research support from MSRA. The institution of Dr. Blum has received research support from PA Research Foundation.
Mike Boggild, MD, FRACP	Dr. Boggild has nothing to disclose.
Karyn L. Boundy, MD (Flinders Medical centre)	No disclosure on file
Bruce Brew, MD, MBBS, DSc, FAAN (St Vincent's Hospital, Univ of New South Wales)	Dr. Brew has received intellectual property interests from a discovery or technology relating to health care. Dr. Brew has received publishing royalties from a publication relating to health care. Dr. Brew has received publishing royalties from a publication relating to health care.
Wallace Brownlee, MD	Dr. Brownlee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Brownlee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Brownlee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Brownlee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Brownlee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Brownlee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Brownlee has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Sage.
Helmut Butzkueven, MD, MBBS	Dr. Butzkueven has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Oxford Health Policy Forum. The institution of Dr. Butzkueven has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. The institution of Dr. Butzkueven has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck. The institution of Dr. Butzkueven has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. The institution of Dr. Butzkueven has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Butzkueven has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for MSBase . The institution of Dr. Butzkueven has received research support from NHMRC. The institution of Dr. Butzkueven has received research support from Biogen. The institution of Dr. Butzkueven has received research support from Roche. The institution of Dr. Butzkueven has received research support from Novartis.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Russell Dale (The Children's Hospital At Westmead)	Mr. Dale has nothing to disclose.
Chandi Das, MD, FRACP (Canberra Hospital (Neurology Dept))	Chandi Das, MD, FRACP has nothing to disclose.
Marzena Pedrini, PhD (Perron Institute for Neurological and Translational Science)	Dr. Pedrini has nothing to disclose.
	No disclosure on file
	No disclosure on file
Simon Hawke	No disclosure on file
Robert N. Heard, MD, FRACP, FRCP (Dr RNS Heard)	No disclosure on file
Andrew Henderson, MD (Westmead Hospital)	Dr. Henderson has nothing to disclose.
Saman Heshmat, MD, MPH (Gold Coast University Hospital)	Dr. Heshmat has nothing to disclose.
Suzanne J. Hodgkinson, MD, MBBS, PhD, FRACP	The institution of Dr. Hodgkinson has received research support from MERCK. The institution of Dr. Hodgkinson has received research support from Atara. The institution of Dr. Hodgkinson has received research support from Biogen . The institution of Dr. Hodgkinson has received research support from Genzyme. The institution of Dr. Hodgkinson has received research support from ROCHE. The institution of Dr. Hodgkinson has received research support from Novartis.
Trevor J. Kilpatrick, MBBS, PhD (Melbourne Neuroscience Institute, University of Melbourne)	Dr. Kilpatrick has received stock or an ownership interest from Mx3 diagnostics. The institution of Dr. Kilpatrick has received research support from NHMRC. The institution of Dr. Kilpatrick has received research support from NMSS. The institution of Dr. Kilpatrick has received research support from MSRA. Dr. Kilpatrick has received intellectual property interests from a discovery or technology relating to health care. Dr. Kilpatrick has received publishing royalties from a publication relating to health care.
John O. King, MD, FRACP, FAAN (Royal Melbourne Hospital)	Dr. King has nothing to disclose.
Christopher Kneebone, FRACP, MBS	Dr. Kneebone has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck.
Andrew J. Kornberg, MD (Royal Childrens Hospital)	Dr. Kornberg has nothing to disclose.
Jeannette Lechner-Scott, MD, PhD, FRACP (HNEAH)	The institution of Prof. Lechner-Scott has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. The institution of Prof. Lechner-Scott has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. The institution of Prof. Lechner-Scott has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. The institution of Prof. Lechner-Scott has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. The institution of Prof. Lechner-Scott has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for elsevier. The institution of Prof. Lechner-Scott has received research support from Merck. The institution of Prof. Lechner-Scott has received research support from Biogen.
	No disclosure on file
Christopher D. Lynch, MD, MBBS, FRACP (Midland Neurology)	Dr. Lynch has nothing to disclose.
Richard A. Macdonell, MD, FAAN (Austin Health)	Dr. Macdonell has nothing to disclose.
Deborah F. Mason, FRACP (Christchurch Public Hospital)	Dr. Mason has nothing to disclose.
Pamela A. McCombe, MD (Dr PA McCombe Medical Pty Ltd)	Dr. McCombe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. McCombe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. McCombe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genzyme. The institution of Dr. McCombe has received research support from Motor Neurone Disease Resaerch Institute of Australia.
Jennifer Pereira, MD (Auckland Hospital)	Dr. Pereira has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Pereira has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Pereira has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche.
John Pollard, MD (University of Sydney)	Dr. Pollard has nothing to disclose.
Sudarshini Ramanathan, MBBS, PhD, FRACP (University of Sydney)	Dr. Ramanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Ramanathan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen, Alexion, Novartis. The institution of Dr. Ramanathan has received research support from NHMRC, RACP, University of Sydney.
Stephen Reddel, MBBS, PhD, FRACP (Sydney Neurology)	Dr. Reddel has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Reddel has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Reddel has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CSL. Dr. Reddel has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Reddel has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Reddel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Jannsen. Dr. Reddel has received personal compensation in the range of $5,000-$9,999 for serving as a NIGAC with Australian Government.
	No disclosure on file
Judith M. Spies, MBBS, PhD (Royal Prince Alfred Hospital)	Dr. Spies has nothing to disclose.
	No disclosure on file
Ian J. Sutton, PhD	Dr. Sutton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Sutton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Sutton has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen.
	No disclosure on file
Michael G. Walsh, MBBS FRACP	No disclosure on file
	No disclosure on file
Eppie Yiu, MD (Royal Children'S Hospital Melbourne)	The institution of Dr. Yiu has received research support from Biogen. The institution of Dr. Yiu has received research support from Roche . The institution of Dr. Yiu has received research support from PTC. The institution of Dr. Yiu has received research support from Pfizer .
	No disclosure on file
Allan G. Kermode, MD, MBBS, FRACP (SJOG Clinic, Suite 314)	Dr. Kermode has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Kermode has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Roche.
Mark Marriott, MBBS (Royal Melbourne Hospital)	No disclosure on file
John Parratt, MD	No disclosure on file
Mark Slee, MBBS, PhD, FRACP (Flinders Medical Centre, Bedford Park)	Dr. Slee has nothing to disclose.
Bruce Taylor (Menzies Research Institue Tasmania)	Bruce Taylor has nothing to disclose.
Ernest W. Willoughby, MD, MB	Dr. Willoughby has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Merck and Roche. Dr. Willoughby has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Willoughby has received personal compensation in the range of $500-$4,999 for serving as a Chair of MS Treatment Assessment Committee with New Zealand Government Pharmaceutical Management Agency. Dr. Willoughby has a non-compensated relationship as a Patron / Medical Advisor with Auckland MS Society that is relevant to AAN interests or activities.
Fabienne Brilot	Fabienne Brilot has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. The institution of Fabienne Brilot has received research support from Novartis.
Angela Vincent, MBBS, MSc (John Radcliffe Hospital)	Angela Vincent, MBBS, MSc has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Lundbeck Foundation. Angela Vincent, MBBS, MSc has received intellectual property interests from a discovery or technology relating to health care.
Patrick Waters, PhD (Oxford Autoimmune Neurology Diagnostic Lab - Nuffield Clinical Neurosciences)	Dr. Waters has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Waters has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Waters has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UBC. The institution of Dr. Waters has received research support from Guthy-Jackson Charitable Foundation. Dr. Waters has received intellectual property interests from a discovery or technology relating to health care.
Simon Broadley, PhD, FRACP (Griffith University School of Medicine)	The institution of Dr. Broadley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. The institution of Dr. Broadley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. The institution of Dr. Broadley has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Broadley has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Broadley has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Broadley has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Sage. The institution of Dr. Broadley has received research support from NHMRC. The institution of Dr. Broadley has received research support from ARC. The institution of Dr. Broadley has received research support from GCH Foundation. The institution of Dr. Broadley has received research support from NHMRC.

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