MRI differences between MOG antibody disease and AQP4 NMOSD

Area of Science:

• Neurology
• Immunology
• Radiology

Background:

• Neuromyelitis optica spectrum disorders (NMOSD) encompass distinct MOG antibody and AQP4 antibody seropositive subtypes.
• These subtypes present with similar clinical symptoms, necessitating advanced diagnostic tools.
• Magnetic Resonance Imaging (MRI) plays a key role in differentiating MOG antibody disease from AQP4 antibody NMOSD.

Purpose of the Study:

• To identify and characterize neuroradiological distinctions between MOG antibody disease and AQP4 antibody NMOSD.
• To establish MRI-based criteria for distinguishing these two NMOSD entities.
• To aid in early and accurate diagnosis of MOG antibody disease versus AQP4 antibody NMOSD.

Main Methods:

• Retrospective analysis of MRI scans from 26 MOG antibody-positive and 25 AQP4 antibody-positive patients.
• Comparative assessment of brain, spinal cord, and orbital MRI features.
• Evaluation of lesion patterns and locations specific to each antibody subtype.

Main Results:

• Orbital MRI abnormalities were predominant in the MOG antibody cohort.
• Spinal cord lesions were more frequently observed in the AQP4 antibody cohort.
• Distinct brain MRI findings included cortical/juxtacortical white matter involvement in MOG antibody disease and rare area postrema involvement.

Conclusions:

• Cortical gray/juxtacortical white matter lesions on brain MRI are potential indicators for distinguishing MOG antibody disease from AQP4-positive NMOSD.
• These MRI findings can assist in differentiating the two conditions, even at initial presentation.
• Accurate differentiation is vital for appropriate treatment strategies in NMOSD management.