AIM/OBJECTIVES/BACKGROUND:This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American Society of Neuroradiology (ASNR), the Society of NeuroInterventional Surgery (SNIS), and the Society for Pediatric Radiology (SPR).This practice parameter provides a consensus-based guide for the safe, effective performance and interpretation of MRA imaging in the head and neck for adults and children. METHODS: This parameter was revised according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Neuroradiology of the ACR Commission on Neuroradiology, the Committee on Practice Parameters - Interventional and Cardiovascular Radiology of the ACR Commission on Interventional and Cardiovascular Radiology, and the Committee on Practice Parameters - Pediatric Radiology of the ACR Commission on Pediatric Radiology in collaboration with the ASNR, the SNIS, and the SPR. RESULTS:The document outlines practice parameters for performing MRA in the head and neck in both adults and children. It reviews the clinical indications for imaging and elaborates on the major imaging techniques with advice for imaging optimization, equipment requirements, reporting standards and potential pediatric adaptations emphasizing consistent practice, patient safety, and the role of evolving technology in neurovascular diagnosis. It is intended to form an educational framework rather than reflect rigid standard of care. CONCLUSIONS:This practice parameter promotes standardized, safe, and clinically effective use of head and neck MRA, ensuring high-quality cerebrovascular imaging while allowing flexibility for evolving technology and individual patient needs.

PURPOSE:To apply the Magnetization Transfer Indirect Spin Labeling (MISL) MRI technique for quantifying tissue-CSF water exchange in the human brain, and to investigate its utility in (1) evaluating tissue-CSF water exchange within perivascular spaces (PVS), and (2) characterizing altered water exchange dynamics in pathologic conditions. METHODS:MISL was implemented on a 3 T MRI using off-resonance magnetization transfer to label parenchymal water. The resulting exchange with CSF was captured via long-TE 3D-TSE readout to suppress parenchymal signals. CSF-region-specific quantification was achieved by atlas-based segmentation. Studies were conducted in healthy subjects across age groups and in patient with metastatic brain tumor. RESULTS:MISL revealed widespread and regionally heterogeneous tissue-CSF exchange, with the strongest signals observed in the PVS and areas adjacent to the choroid plexus. MISL signals were typically 2%-3% in the ventricles and subarachnoid space, and reached 3% in the cerebellar regions, suggesting tissue-to-CSF flow (TCF) in the range of 100-300 mL/100 mL/min. The high MISL signals observed in the PVS (∼8.4%) indicated active tissue-CSF water exchange, providing functional information of the PVS that conventional T2w imaging cannot capture. Significant age-dependent declines in TCF were observed across most brain regions, except for the third and fourth ventricles. In the tumor patient, MISL revealed elevated water exchange, even where no overt FLAIR hyperintensity was present. CONCLUSION:MISL enables robust, non-invasive mapping of tissue-CSF exchange with high sensitivity and spatial resolution. MISL provides a unique window into tissue-CSF exchange within PVS, which may reflect glymphatic function.

BACKGROUND AND PURPOSE:Tuberous sclerosis complex (TSC) is a genetic disorder that affects multiple organs, particularly the brain, and is associated with neurologic impairments such as cognitive deficits and seizures. There are relatively few prior studies investigating brain metabolites in TSC. The aim of this study was to investigate neurochemical alterations in TSC, focusing on cortical/subcortical glioneuronal tubers as well as normal-appearing regions, and comparing them with matched healthy control subjects. MATERIALS AND METHODS:The study included 19 subjects with TSC (mean, 15.9 [SD, 9.5] years), and 33 age- and sex-matched healthy controls (mean, 19.7 [SD, 8.2] years). Multislice 2D-MR spectroscopic imaging was used for quantification of metabolites, including total N-acetylaspartate (tNAA), choline (tCho), creatine (tCr), glutamate and glutamine (Glx) and myo-inositol (mI) in both tubers and normal-appearing brain regions in individuals with TSC and comparing them with those in control subjects. Metabolite ratios were also examined for correlation with age. RESULTS:mI/tCr was significantly elevated in TSC compared with controls in WM, GM, and tubers (P < .05 or better). In addition, both tNAA/tCr and tCho/tCr were decreased in tubers and in normal-appearing WM compared with controls (P < .001). Finally, Glx/tCr was elevated in tubers compared with controls (P < .05), and individuals with TSC did not exhibit age-related Glx/tCr decreases that were observed in controls in both GM and WM. CONCLUSIONS:Subtle, but significant metabolic abnormalities were found for subjects with TSC compared with healthy controls, both in tubers and in normal-appearing brain regions. The variation of metabolite levels as a function of age also differed between TSC and controls. These findings may provide information on the underlying pathophysiology of TSC, and future work is needed to investigate the relationships of these findings to neurologic symptoms, including seizures and cognitive impairment.

AIM/OBJECTIVES/BACKGROUND: This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American Society of Neuroradiology (ASNR), and the Society for Pediatric Radiology (SPR). The practice parameter has been updated to reflect current performance of CT angiography of the head and neck with the inclusion of newly-available information since the last revision. METHODS: This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters ? Neuroradiology of the ACR Commission on Neuroradiology and the Committee on Practice Parameters ? Pediatric Radiology of the ACR Commission on Pediatric Radiology in collaboration with the ASNR, and the SPR. RESULTS: CTA is a widely-used modality in neuroradiology, and is critically important for diagnosis and monitoring of numerous conditions. This updated practice parameter provides information on indications, patient preparation, equipment specifications, examination performance, and interpretation of head and neck CTA in current practice. CONCLUSIONS: This practice parameter can be used to establish or modify a head and neck CTA protocol based on current evidence and recommendations.

To determine whether quantitative molecular parameters derived from saturation transfer MR fingerprinting (ST-MRF) can differentiate tumor progression from treatment-related change and provide prognostic information in IDH-wildtype glioblastoma. In this retrospective single-center study, 24 patients (median age, 59.5 years; interquartile range, 47–68.5 years) with histologically confirmed glioblastoma underwent ST-MRF on a 3-T clinical MRI system for suspected progression after concurrent chemoradiation therapy. ST-MRF parameters included amide proton transfer (APT), Amine-CEST, relayed nuclear Overhauser enhancement (rNOE), and magnetization transfer contrast (MTC) components. Tumor progression versus treatment-related change was determined by pathology or clinico-radiologic consensus using RANO 2.0 criteria. Diagnostic performance was assessed with logistic regression and receiver operating characteristic analysis. Overall survival (OS) was evaluated with Cox proportional hazards models and Harrell’s concordance index (C-index). Tumor progression demonstrated significantly higher APT1µT (11.2 ± 0.8

MRSI is a non-invasive tool for mapping metabolic distributions in multi-focal or other diseases where the location of abnormalities may be uncertain. High-concentration metabolites can be investigated at 3T using non-edited MRSI, whereas lower-concentration metabolites, such as GABA, typically require specialized editing techniques because of spectral overlap. This study reports on the reproducibility of a protocol containing both co-localized short-TE and GABA-edited multi-slice spin-echo 2D MRSI. Multi-slice, short-TE (TE 20 ms) and GABA-edited (TE 68 ms) MRSI at a nominal spatial resolution of 2.2 cm3 was performed twice (7 to 14 days apart) at 3T on 11 healthy volunteers (age range 7 to 43 years). Data analysis was performed in the "Osprey" software package, including retrospective motion compensation, consensus-recommended processing, and linear-combination modeling. Metabolite estimates for six metabolites were quantified relative to total creatine (tCr) and water in 14 regions of interest. Reproducibility was assessed using intra- and inter-subject coefficients of variation. Short-TE MRSI metabolite estimates for total N-acetylaspartate (tNAA), tCr, total choline (tCho), myo-inositol (mI), and the sum of glutamate and glutamine (Glx) were found to be highly reproducible for both creatine- and water-referenced concentration estimates, with 77% of the regions of interest meeting the quality-control criteria for both visits and 96% for at least one visit. Average intra-subject CVs were 5.8% and 4.8%, and inter-subject CVs were 11.1% and 9.7% for water-referenced and tCr-referenced estimates, respectively. For GABA+ (GABA + macromolecules) estimates, 46% of the voxels of interest met quality-control criteria for both visits, and 82% for at least one visit. In the remaining datasets, the average intra-subject CVs were 13.5% for both quantification methods, and the inter-subject CVs were 13.5% and 16.9% for water-referenced and creatine-referenced estimates, respectively. 3T-MRSI sequences can achieve reproducible mapping with extended brain coverage of five major metabolites (tNAA, tCr, tCho, mI, and Glx). Reproducibility assessment for GABA+ mapping remains challenging, with 18% of the data being rejected in at least one visit, but it yielded acceptable reproducibility in datasets that met quality control criteria in both visits (46%).

Purpose: Magnetic resonance spectroscopic imaging (MRSI) is a versatile technique to investigate the spatial distribution of in vivo metabolism. However, processing MRSI data is demanding, and only a few software packages support end-to-end analysis. The goal of this study was to implement fully automated, end-to-end MRSI analysis into the open-source 'Osprey-MRSI' software package. Methods: MRSI-specific analysis and visualization capabilities were implemented, building on the existing Osprey workflow. Modifications included spatial transformation and filtering operations, automated brain masking and tissue segmentation of the MRSI data, improved lipid filtering, rapid integral maps, linear-combination modeling with explicit B0 frequency-shift correction, and generation of quality-control maps and metabolic images. A fully interactive GUI and semi-interactive HTML reports provide a user-friendly way to inspect each step of the analysis. All analysis derivatives are also exported in NIfTI and NIfTI-MRS format for easy visualization and synergies with other toolboxes and modalities. Results: The automated MRSI workflow was successfully used to analyze short- and medium-TE 3T in vivo MRSI datasets from all major vendors (Philips, GE, Siemens) across multiple sites. Correct coregistration of MRSI data and MR images was validated using phantom data from each vendor and existing MRSI processing tools. Conclusion: Osprey-MRSI offers state-of-the-art methods with minimal user interaction available for non-expert users. The modularity of the workflow and the modeling algorithm will foster innovation and development of novel MRSI-specific analysis methods.

BACKGROUND AND PURPOSE:Spinal cord stroke (SCS) is rare, and is frequently misdiagnosed. This study describes the clinical and radiological characteristics of vertebral body infarction (VBI) associated with SCS. MATERIALS AND METHODS:To assess VBI in patients with SCS, we retrospectively reviewed clinical data and magnetic resonance imaging from patients diagnosed at a specialized referral center. VBI was defined as T2-weighted hyperintensity within a vertebral body near ischemic cord lesions. Additional features, including gadolinium enhancement, lesion distribution, and exclusion of other explanations, were also analyzed. Each vertebra was evaluated for level, pattern of signal changes, and enhancement, and then correlated with lesion distribution and the related spinal arterial supply. RESULTS:Among 126 patients with SCS, 15 (12 %) showed MRI evidence of VBI. Twelve patients (80 %) had multiple vertebrae affected. Of the 32 vertebrae displaying signs of VBI, 18 (56 %) were thoracic, 9 (28 %) were cervical, and 5 (16 %) were lumbar. In 80 % of SCS cases, MRI abnormalities of VBI were found at the same or lower vertebral levels as the cord lesions; these were typically hyperintense on T2-weighted and STIR sequences, with 92 % showing contrast enhancement. The location of the ischemic lesions in the vertebral bodies was anterolateral (44 %), posteromedian (22 %), hemivertebral (19 %), or posterolateral (9 %), with two vertebrae showing diffuse involvement. The spinal vascular territories included the artery of Adamkiewicz (n = 10, 67 %), the superior artery of the cervical enlargement (n = 6, 40 %), the artery of von Haller (n = 5, 33 %), and the inferior artery of the cervical enlargement in three cases (20 %). CONCLUSION:The co-occurrence of VBI and SCS is attributable to their shared arterial supply, as MRI findings in VBI generally mirror the spinal vascular anatomy. VBI reflects vascular injury and serves as a supportive imaging sign for SCS.

PURPOSE:To improve the quantification of existing multi-timepoint arterial spin labeling (ASL) methods in estimating cerebral blood flow (CBF) and arterial transit time (ATT) for a wider range of ATTs. METHODS:MULti-TImepoint VElocity-selective Reconciled with Spatially-sElective (MULTIVERSE) ASL utilizes multi-delay pseudo-continuous (PC) ASL and velocity-selective (VS) ASL with spatially defined bolus, and joint fitting to estimate CBF and ATT. Numerical simulations were performed to evaluate the accuracy and precision of single-delay and multi-delay PCASL and VSASL, as well as the proposed MULTIVERSE ASL, in quantifying CBF and ATT across an extended range of ATTs. The CBF and ATT estimates between multi-delay PCASL, VSASL, and MULTIVERSE ASL were compared across healthy volunteers. RESULTS:Numerical simulations showed that the utility of MULTIVERSE ASL improved the accuracy and precision over an extended ATT range of up to 4000 ms. In vivo scans from healthy subjects demonstrated that MULTIVERSE ASL led to reduced uncertainty in CBF and ATT quantification compared to multi-post-labeling delay PCASL while maintaining comparable repeatability. CONCLUSION:This novel and straightforward approach improves the accuracy and precision of the fitted CBF and ATT over an extended range of ATT, which is not possible with existing ASL methods. Brain scans from healthy subjects demonstrated the feasibility and reliability of the technique, highlighting the clinical potential of ASL-based perfusion mapping in various altered physiological and pathological conditions.

BACKGROUND AND PURPOSE:In in vivo magnetic resonance spectroscopy (MRS) of the brain, glycine (Gly) is traditionally separated from the overlapping signal of myo-inositol (mI) through the use of intermediate (e.g., 130-140 ms) or long (270-280 ms) echo times (TE). However, no quantitative comparisons have been performed to date comparing the performance of clinically available MRS sequences to differentiate mI and Gly as a function of TE. METHODS:In vivo spectra recorded with two clinically available MRS pulse sequences (single voxel PRESS and semi-LASER 2D-MRSI) with short (35 ms), intermediate (135 ms), and long (280 ms) echo times in a neonate with clinically suspected nonketotic hyperglycinemia were compared to those recorded from phantoms, and spectral simulations. RESULTS:In vivo spectra recorded at short and intermediate TE spectra showed signals at 3.5 ppm that could arise from either mI or Gly; however, long TE spectra showed an absence of signal in this spectral region, which was consistent with the final clinical diagnosis of hypoxic-ischemic encephalopathy. Phantom data and spectral simulations demonstrated that at intermediate TE, mI has a "pseudo-singlet" appearance that is very similar to that of Gly. CONCLUSIONS:Long echo times are used to best discriminate Gly from mI if specialized sequences and analysis methods are not available. Quantitative spectral analysis methods may also assist in correctly assigning Gly and mI.

Advances in treatments of autoimmune diseases, acquired immunodeficiency syndrome, organ transplantation, and the use of long-term devices have increased the rates of atypical infections due to prolonged immune suppression. There is a significant overlap in imaging findings of various fungal infections affecting the central nervous system (CNS), often mimicking those seen in neoplastic and noninfectious inflammatory conditions. Nonetheless, there are imaging characteristics that can aid in distinguishing certain atypical infections. Hence, familiarity with a wide range of infectious agents is an important part of diagnostic neuroradiology. In this article, an in-depth review of fungal diseases of the CNS is provided.

The most-used 3D acquisition for ASL at 3T is GRASE or stack-of-spiral (SOS) based FSE, which requires multiple shots to cover the full k-space. Alternatively, turbo FLASH (TFL) acquisition allows longer echo trains with slower T1 (than T2) relaxation, and 3D SOS-TFL has the potential to reduce the number of shots to even single-shot, thus improving the temporal resolution for ASL. Here we demonstrated comparable performance of 3D SOS-TFL with 3D GRASE on PCASL- and VSASL-derived CBF mapping and VSASL-derived CBV mapping at 3T on 12 healthy subjects, and the utility of 3D SOS-TFL on a stroke patient.

Post-acute COVID-19 syndrome (PCS) is highly prevalent. Critically ill patients requiring intensive care unit (ICU) admission are at a higher risk of developing PCS. The mechanisms underlying PCS are still under investigation and may involve microvascular damage in the brain. Cerebral misery perfusion, characterized by reduced cerebral blood flow (CBF) and elevated oxygen extraction fraction (OEF) in affected brain areas, has been demonstrated in cerebrovascular diseases such as carotid occlusion and stroke. This pilot study aimed to examine whether COVID-19 ICU survivors exhibited regional misery perfusion, indicating cerebral microvascular damage. In total, 7 COVID-19 ICU survivors (4 female, 20–77 years old) and 19 age- and sex-matched healthy controls (12 female, 22–77 years old) were studied. The average interval between ICU admission and the MRI scan was 118.6 ± 30.3 days. The regional OEF was measured using a recently developed technique, accelerated T2-relaxation-under-phase-contrast MRI, while the regional CBF was assessed using pseudo-continuous arterial spin labeling. COVID-19 ICU survivors exhibited elevated OEF (β = 5.21 ± 2.48%, p = 0.047) and reduced relative CBF (β = −0.083 ± 0.025, p = 0.003) in the frontal lobe compared to healthy controls. In conclusion, misery perfusion was observed in the frontal lobe of COVID-19 ICU survivors, suggesting microvascular damage in this critical brain area for high-level cognitive functions that are known to manifest deficits in PCS. Physiological biomarkers such as OEF and CBF may provide new tools to improve the understanding and treatment of PCS.

Abstract Management of imaging progression on standard contrast enhanced MRI (cMRI) after SRS for brain metastasis is challenging as treatment effect/necrosis appears similar to progressive tumor. VSASL-MRI uses water labeled based on velocity, rather than spatial location, as an endogenous contrast agent and is therefore insensitive to transit delay impacting other ASL-MRI techniques. Other advantages include no IV contrast, limited susceptibility artifact, and absence of confounding leakage of gadolinium contrast into tissues. VSASL-MRI was performed (median 15 (4-123) months after SRS) to evaluate SRS treated solid tumor BM with clinician determined imaging progression on cMRI to evaluate the hypothesis that VSASL-MRI may distinguish biologic tumor (hyperperfused compared with normal brain) from treatment effect/necrosis (hypoperfused). 17 patients (19 progressing lesions) were enrolled. 13/19 index lesions had hypoperfusion. Of these, 3/13 had resection with no tumor present, 8/13 were conservatively managed and appeared to be treatment effect/necrosis as they stabilized or improved on follow-up cMRI without further BM directed intervention, and 2/13 had resection for further progression with active tumor present. For 6 index lesions that were hyperperfused: 3/6 had pathology were confirmed to be tumor, whereas the other 3/6 continued to progress (one got additional RT, two expired with progression). In addition, two pts had concurrent identification of new non-index previously untreated lesions on cMRI that were hyperperfused on VSASL-MRI and were treated. One of these patients had subsequent VSASL-MRI demonstrating post-SRS resolution of perfusion 2 months after treatment. This pilot data supports the hypothesis that VSASL-MRI may be useful in distinguishing tumor progression from radiation related imaging changes and/or be an early biomarker of radiosurgery response. We are initiating further study (1R01CA282928-01, PI; Qin) to refine the technique and prospectively assess the value of this approach in a larger number of patients.

Atypical infections of the brain and spine caused by parasites occur in immunocompetent and immunosuppressed hosts, related to exposure and more prevalently in endemic regions. In the United States, the most common parasitic infections that lead to central nervous system manifestations include cysticercosis, echinococcosis, and toxoplasmosis, with toxoplasmosis being the most common opportunistic infection affecting patients with advanced HIV/AIDS. Another rare but devastating transmittable disease is prion disease, which causes rapidly progressive spongiform encephalopathies. Familiarity and understanding of various infectious agents are a crucial aspect of diagnostic neuroradiology, and recognition of unique features can aid timely diagnosis and treatment.

Objective The brain arteriovenous malformation (BAVM) nidus compactness score (CS), determined on angiography, predicts BAVM recurrence after surgical resection among children with sporadic BAVMs. We measured the angiographic CS for BAVMs among children with hereditary hemorrhagic telangiectasia (HHT) to determine CS characteristics in this population. Methods A pediatric interventional neuroradiologist reviewed angiograms to determine the CS of BAVMs in children with HHT recruited to the BVMC. CS is based on overall nidus and perinidal anomalous vessel compactness. CS categories included 1 = diffuse nidus, 2 = intermediate nidus, and 3 = compact nidus. Results Forty-eight of 78 children (61.5%) with HHT and brain vascular malformations had a conventional angiogram; 47 (97.9%) angiograms were available. Fifty-four BAVMs were identified in 40 of these 47 children (85.1%). Of 54 BAVMs in children with HHT, CS was 1 in 7 (13%), 2 in 29 (53.7%), and 3 in 18 BAVMs (33.3%) compared with CS of 1 in six (26.1%), 2 in 15 (65.2%), and 3 in 2 BAVMs (8.7%) among 23 previously reported children with sporadic BAVMs, p = 0.045 (Fisher’s exact). Seven children with HHT had intracranial hemorrhage: 4 had CS = 3, 1 had CS = 2, and 2 had CS = 1. Conclusions A range of CSs exists across HHT BAVMs, suggesting it may be an angiographic measure of interest for future studies of BAVM recurrence and hemorrhage risk. Children with HHT may have more compact niduses compared to children with sporadic BAVMs. Additional research should determine whether CS affects hemorrhage risk or post-surgical recurrence risk in HHT-associated BAVMs, which could be used to direct BAVM treatment.

Hemorrhagic Destruction of the Brain, Subependymal Calcification, and Congenital Cataracts (HDBSCC) is a rare syndrome caused by biallelic mutations in the JAM3 gene with significant intrafamilial variability in clinical presentation and brain imaging phenotypes. The clinical presentation of HDBSCC includes severe recurrent hemorrhages involving the brain parenchyma and the ventricles beginning in utero and continuing in infancy together with dense central cataracts present at birth. This comprehensive review documents reported cases on this unique condition and describes its genetic, neuroradiologic and ophthalmic features. It should be included in the differential diagnosis of children with congenital cataracts and neurodevelopmental abnormalities. Unique clinical, imaging findings and genetic testing can help the diagnosis.

MR perfusion imaging is important in the clinical evaluation of primary brain tumors, particularly in differentiating between true progression and treatment-induced change. The utility of velocity-selective ASL (VSASL) compared to the more commonly utilized DSC perfusion technique was assessed in routine clinical surveillance MR exams of 28 patients with high-grade gliomas at 1.5T. Using RANO criteria, patients were assigned to two groups, one with detectable residual/recurrent tumor (“RT”, n = 9), and the other with no detectable residual/recurrent tumor (“NRT”, n = 19). An ROI was drawn to encompass the largest dimension of the lesion with measures normalized against normal gray matter to yield rCBF and tSNR from VSASL, as well as rCBF and leakage-corrected relative CBV (lc-rCBV) from DSC. VSASL (rCBF and tSNR) and DSC (rCBF and lc-rCBV) metrics were significantly higher in the RT group than the NRT group allowing adequate discrimination (p < 0.05, Mann–Whitney test). Lin’s concordance analyses showed moderate to excellent concordance between the two methods, with a stronger, moderate correlation between VSASL rCBF and DSC lc-rCBV (r = 0.57, p = 0.002; Pearson’s correlation). These results suggest that VSASL is clinically feasible at 1.5T and has the potential to offer a noninvasive alternative to DSC perfusion in monitoring high-grade gliomas following therapy.

BackgroundCriteria for multiple sclerosis (MS) diagnosis rely upon clinical and paraclinical data that are supportive of MS in the absence of a better explanation. Patients referred for consideration of a MS diagnosis often undergo an extensive serologic workup including antinuclear antibody (ANA) testing, even when an individual already meets diagnostic criteria for MS. It is unclear whether ANA serostatus is associated with clinical outcomes in MS. The present study aims to determine if ANA seropositivity in those referred with concern for MS differs in those who meet 2017 revised McDonald criteria compared to those who did not receive a diagnosis of MS. Associations between ANA seropositivity and clinical or radiological phenotype of MS patients are also explored.MethodsThe cohort included people at least 18 years old, referred to our tertiary care MS center with concern for MS (regardless of prior diagnosis) who had an ANA test with known titer completed within one year of first evaluation. Electronic health record (EHR) charts were manually reviewed, and MRIs underwent blinded review by a radiologist with training in neuroradiology. Diagnosis of MS was determined by a neuroimmunologist and was based on 2017 revised McDonald Criteria. Results are reported as odds ratios from multivariable logistic regression analyses adjusted for age, sex at birth, race, smoking history, personal history of comorbid autoimmune conditions, and family history of autoimmunity. Within the MS cohort, similar analytical models were performed to assess association between ANA and clinical and radiological characteristics.ResultsA final cohort of 258 patients was analyzed (out of 542 referrals): 106 nonMS and 152 with MS. There was no association between MS (vs. nonMS) diagnosis and ANA status (ANA positive n = 74) in the multivariable models (OR 1.5, 95 % CI 0.82, 2.72, p = 0.20). Among those with MS, there was no association of ANA seropositivity with the odds of atypical brain MRI features, number of cardinal MRI areas involved, location of MRI lesions, or of having an atypical presentation of first demyelinating event. Black race (OR 2.8, 95 % CI 1.27, 6.26, p = 0.01) and family history of autoimmunity (OR 2.1, 95 % CI 1.09, 3.98, p = 0.03) were independently associated with increased odds of ANA positivity. Within the MS cohort analysis, progressive MS (PMS; vs relapsing-remitting MS), a covariate in the model, appeared to be at higher odds of being ANA positive (OR 3.6, 95 % CI 1.03, 13.05, p = 0.046) but only when assessing mean area of cardinal MS locations.ConclusionsWhile ANA testing does not appear to be useful in distinguishing MS from non-MS, it remains less clear as to whether it may be associated with differences in the clinical course of MS (relapsing-remitting vs progressive). Future studies should aim to systematically evaluate whether those who are ANA positive are more likely, in well-designed and representative prospective cohorts, to be diagnosed with or develop progressive MS. Whether a positive ANA early in MS is associated with increased risk over time of developing or diagnosing another systemic autoimmune disease would also be of interest.