目的:本研究旨在确定磁共振成像(MRI)生物标志物是否与髓鞘少突胶质细胞蛋白(MOG-ON)相关视神经炎(MOG-ON)的视觉预后相关。
方法:横断面分析。
方法:纳入了符合2023年MOG抗体相关疾病国际诊断标准的患者,这些患者在2017年1月至2023年7月期间在三次三级神经眼科实践中首次出现MOG-ON。接受少于3个月的神经眼科随访且在此期间未显示视力恢复(视力[VA]≥20/20和视野平均偏差[VFMD]>-5.0dB)的患者被排除在外。
方法:患者接受对比增强,症状出现后一个月内,大脑和轨道的脂肪抑制MRI。
方法:放射学生物标志物与不良VA结果之间的关联(<20/40),不完全VA恢复(<20/20),使用多变量逻辑回归对从症状发作到治疗的时间以及最低点VA或VFMD进行调整,评估了不良的VFMD结局(VFMD<-5.0dB)。放射学生物标志物包括视神经增强的长度(低于25%以上,50%,和75%);轨道度,小管,和颅内或交叉视神经增强(轻度与与泪腺相比,中度-重度);以及缺席与基线T1加权MRI上存在视神经鞘增强。
结果:92例患者共129只眼(中位[IQR]年龄37.0[20.8-51.3],65.2%的女性)被包括在内。在6.2%的病例中发现了不良的VA结果,不完全VA恢复19.4%,和不良的VFMD结果为16.9%。与中度-重度增强的眼睛相比,轻度眼眶视神经增强的眼睛更有可能出现不良VA结局(OR8.57;95%CI[1.85,51.14],P=0.009),不完全VA恢复(OR7.31,95%CI[2.42,25.47],P=0.001),和不良的VFMD结局(调整治疗时间:OR6.81,95%CI[1.85,28.98],P=0.005;调整最低点VFMD:OR11.65,95%CI[1.60,240.09],P=0.04)。视神经鞘增强缺乏与VA恢复不完全相关(OR3.86,95%CI[1.19,12.85],P=0.02)与增强的存在相比。在开始治疗前进行的MRI的亚组逻辑回归分析中,这些相关性保持一致,但在治疗后进行的MRI的成对分析中未发现。
结论:在第一次MOG-ON发作的眼睛中,眶视神经轻度增强与VA和VF恢复较差相关。需要前瞻性和机械性研究来确认MRI在MOG-ON中的预后效用。
OBJECTIVE: This study aimed to determine whether magnetic resonance imaging (MRI) biomarkers are associated with visual prognosis in myelin oligodendrocyte protein (MOG)-associated optic neuritis (MOG-ON).
METHODS: Cross-sectional analysis.
METHODS: Patients meeting 2023 international diagnostic criteria for MOG antibody-associated disease who were seen for first episodes of MOG-ON at three tertiary neuro-ophthalmology practices between January 2017 and July 2023 were enrolled. Patients who received less than 3 months of neuro-ophthalmic follow-up and did not demonstrate visual recovery (visual acuity [VA] ≥20/20 and visual field mean deviation [VFMD] >-5.0 dB) during this time were excluded.
METHODS: Patients received contrast-enhanced, fat-suppressed MRI of the brain and orbits within one month of symptom onset.
METHODS: The associations between radiological biomarkers and poor VA outcome (<20/40), incomplete VA recovery (<20/20), and poor VFMD outcome (VFMD <-5.0 dB) were assessed using multivariable logistic regression adjusting for time from symptom onset to treatment and nadir VA or VFMD. Radiological biomarkers included length of optic nerve enhancement (below vs. above 25%, 50%, and 75%); degree of orbital, canalicular, and intracranial or chiasmal optic nerve enhancement (mild vs. moderate-severe compared to the lacrimal gland); and absence vs. presence of optic nerve sheath enhancement on baseline T1-weighted MRI.
RESULTS: A total of 129 eyes of 92 patients (median [IQR] age 37.0 [20.8-51.3], 65.2% female) were included. Poor VA outcome was seen in 6.2% of cases, incomplete VA recovery in 19.4%, and poor VFMD outcome in 16.9%. Compared to eyes with moderate-severe enhancement, eyes with mild orbital optic nerve enhancement were more likely to have poor VA outcome (OR 8.57; 95% CI [1.85, 51.14], P=0.009), incomplete VA recovery (OR 7.31, 95% CI [2.42, 25.47], P=0.001), and poor VFMD outcome (adjusting for time to treatment: OR 6.81, 95% CI [1.85, 28.98], P=0.005; adjusting for nadir VFMD: OR 11.65, 95% CI [1.60, 240.09], P=0.04). Lack of optic nerve sheath enhancement was additionally associated with incomplete VA recovery (OR 3.86, 95% CI [1.19, 12.85], P=0.02) compared to the presence of enhancement. These associations remained consistent in subgroup logistic regression analysis of MRIs performed before initiation of treatment but were not seen in pairwise analysis of MRIs performed after treatment.
CONCLUSIONS: In eyes with first MOG-ON episodes, milder enhancement in the orbital optic nerve is associated with poorer VA and VF recovery. Prospective and mechanistic studies are needed to confirm the prognostic utility of MRI in MOG-ON.