Journal of neurology · 2026
Cerebrovascular risk factors impact on brain atrophy and DTI-ALPS decrease in neuromyelitis optica spectrum disorder.
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Rubin Martina, Preziosa Paolo, Margoni Monica, Storelli Loredana, Pagani Elisabetta, Valsasina Paola, Albergoni Matteo, Moiola Lucia, Filippi Massimo, Rocca Maria A
Аннотация
BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy where disability is largely relapse-driven. Cerebrovascular risk factors (cVRFs) may exacerbate astrocytic and small-vessel injury. Therefore, we investigated their impact on MRI damage and disability in NMOSD.
METHODS: Twenty-eight aquaporin 4 immunoglobulin G-positive NMOSD patients and 56 age- and sex-matched healthy controls (HC) underwent 3T brain and cervical MRI, cVRF and neurological assessment, including the Expanded Disability Status Scale (EDSS). Brain T2-hyperintense white matter lesion volume (WMLV), normalized global and regional volumes, normal-appearing WM (NAWM) fractional anisotropy (FA) and mean diffusivity (MD), diffusion tensor imaging analysis along the perivascular spaces (DTI-ALPS) index, spinal cord lesion volume (SCLV) and normalized cross-sectional area (nCSA) were quantified.
RESULTS: cVRF were present in 57% of NMOSD and 39% of HC, with smoking being the most frequent (all FDR-p = 0.734). Compared to HC, NMOSD showed significantly higher brain WMLV and SCLV, lower normalized brain (NBV), and deep gray matter volume (nDGMV) (all FDR-p ≤ 0.030). Significant diagnosis × cVRF interactions were found for nDGMV and DTI-ALPS (all FDR-p ≤ 0.038). In NMOSD, higher EDSS significantly correlated with lower DTI-ALPS (r = - 0.47, FDR-p = 0.048) and higher SCLV (r = 0.54, FDR-p = 030). Moderation analysis revealed that cVRFs significantly amplified the association between DTI-ALPS and disability (FDR-p = 0.045).
CONCLUSIONS: cVRFs amplify CNS damage and the clinical impact of impaired neurofluid dynamics in NMOSD, suggesting convergent vascular and astrocytic injury.
METHODS: Twenty-eight aquaporin 4 immunoglobulin G-positive NMOSD patients and 56 age- and sex-matched healthy controls (HC) underwent 3T brain and cervical MRI, cVRF and neurological assessment, including the Expanded Disability Status Scale (EDSS). Brain T2-hyperintense white matter lesion volume (WMLV), normalized global and regional volumes, normal-appearing WM (NAWM) fractional anisotropy (FA) and mean diffusivity (MD), diffusion tensor imaging analysis along the perivascular spaces (DTI-ALPS) index, spinal cord lesion volume (SCLV) and normalized cross-sectional area (nCSA) were quantified.
RESULTS: cVRF were present in 57% of NMOSD and 39% of HC, with smoking being the most frequent (all FDR-p = 0.734). Compared to HC, NMOSD showed significantly higher brain WMLV and SCLV, lower normalized brain (NBV), and deep gray matter volume (nDGMV) (all FDR-p ≤ 0.030). Significant diagnosis × cVRF interactions were found for nDGMV and DTI-ALPS (all FDR-p ≤ 0.038). In NMOSD, higher EDSS significantly correlated with lower DTI-ALPS (r = - 0.47, FDR-p = 0.048) and higher SCLV (r = 0.54, FDR-p = 030). Moderation analysis revealed that cVRFs significantly amplified the association between DTI-ALPS and disability (FDR-p = 0.045).
CONCLUSIONS: cVRFs amplify CNS damage and the clinical impact of impaired neurofluid dynamics in NMOSD, suggesting convergent vascular and astrocytic injury.