Latin American consensus recommendations on the role of magnetic resonance imaging in neuromyelitis optica spectrum disorder in clinical practice.
Authors
Affiliations (20)
Affiliations (20)
- Neuroimmunology Unit, Department of Neurosciences, Hospital Aleman, Buenos Aires, Argentina; CENRos, Neuroimmunology Clinic, INECO Neurociencias Oroño, Rosario, Argentina. Electronic address: [email protected].
- Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina; Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.
- Department of Neurology, Fleni, Buenos Aires, Argentina; Instituto de Química y Fisicoquímica Biológicas (IQUIFIB), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina.
- Centro Universitario de Esclerosis Múltiple (CUEM), Hospital Ramos Mejía y Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina.
- Hospital São Lucas/Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
- Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile; Servicio de Neurología, Complejo Asistencial Doctor Sótero del Río, Santiago, Chile; Servicio de Neurología, Red de Salud UC Christus, Santiago, Chile.
- Department of Neurology, Hospital Carlos Andrade Marín, Quito, Ecuador.
- Department of Radiology and Oncology, Universidade de São Paulo, SP, Brazil; Department of Radiology, Fleury Group, São Paulo, SP, Brazil.
- Department of Neurology, Fleni, Buenos Aires, Argentina; Entelai, Buenos Aires, Argentina; Centro Para la Investigación de Enfermedades Neuroinmunológicas, Buenos Aires, Argentina.
- Clínica Alemana, Santiago de Chile, Chile; Clínica Dávila, Santiago de Chile, Chile.
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Mexico.
- Department of Neurology, Hospital Santo Tomás, Panama City, Panama; Instituto Conmemorativo Gorgas de Estudios de la Salud, Universidad Interamericana de Panama, Panama City, Panama.
- Grupo Investigacion SINAPSIS, Departamento de Neurología, Clínica Universitaria Colombia, Bogotá, Colombia; Hospital de San José, Departamento Neurología, Bogota, Colombia.
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.
- Neuroimmunology Clinic, National Institute of Neurology and Neurosurgery of Mexico, Manuel Velasco Suárez, Mexico.
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre, RS, Brazil.
- Neurology Department, Hospital Clínico de Maracaibo, Maracaibo, Venezuela.
- Neuroimmunology Unit, Neurology Department, Hospital de Clínicas, Buenos Aires, Argentina.
- Neuroimmunology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
- The Mellen Center for Multiple Sclerosis and Research, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune astrocytopathy in which magnetic resonance imaging (MRI) plays a central role in diagnosis, relapse confirmation, differential diagnosis, and longitudinal monitoring. Despite its clinical relevance, standardized MRI recommendations tailored to regional practice are lacking, particularly in Latin America (LATAM), where access to imaging resources and expertise is heterogeneous. Using a modified RAND/UCLA Delphi methodology, a multidisciplinary panel of LATAM experts in neurology, neuroimmunology, neuroradiology, and methodology developed consensus recommendations on the use of MRI in NMOSD. Statements were informed by a narrative review of the literature and rated using a 9-point Likert scale across iterative rounds. Consensus was predefined as a median score ≥7 with limited dispersion. Recommendations were stratified according to feasibility in real-world LATAM settings. Consensus was achieved for use of MRI at disease onset, relapse assessment, routine follow-up, differential diagnosis, evaluation of disease activity and treatment response, and the role of advanced techniques and artificial intelligence (AI). Standardized brain and spinal cord MRI are recommended at diagnosis, complemented by orbital imaging when optic neuritis is suspected. MRI contributes substantially to relapse adjudication, particularly in clinically mild or ambiguous presentations. During follow-up, MRI assists in differential diagnosis, detection of subclinical activity, prognostication, and treatment monitoring, although routine contrast use is not required in stable patients. Advanced MRI and AI-based tools are considered complementary, with current utility focused on research and registry-based applications. These LATAM-adapted consensus recommendations provide a practical, evidence-informed framework for MRI use in NMOSD, aiming to improve diagnostic accuracy, harmonize imaging practices, and optimize patient management across diverse healthcare settings.