Brighter spotty lesions on spinal MRI help differentiate AQP4 antibody-positive NMOSD from MOGAD

Area of Science:

• Neurology
• Radiology
• Immunology

Background:

• Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are distinct autoimmune inflammatory conditions affecting the central nervous system.
• Accurate differentiation is crucial for appropriate treatment and prognosis.
• Spinal magnetic resonance imaging (MRI) plays a key role in diagnosing these conditions.

Purpose of the Study:

• To investigate the diagnostic utility of brighter spotty lesions (BSLs) on spinal MRI in distinguishing aquaporin-4 antibody-positive NMOSD (AQP4-NMOSD) from MOGAD.
• To assess the prevalence of BSLs in patients with AQP4-NMOSD and MOGAD during the acute phase of myelitis.

Main Methods:

• Retrospective analysis of 133 spinal MRI scans from patients with confirmed MOGAD (n=65) and AQP4-NMOSD (n=68).
• Scans were acquired within one month of disease onset.
• Independent review by an experienced neuroradiologist and two neurologists to identify BSLs.

Main Results:

• Brighter spotty lesions (BSLs) were identified in 30% (18/61) of AQP4-NMOSD patients.
• No BSLs were observed in any MOGAD patients (0/49).
• The presence of BSLs was statistically significant in differentiating AQP4-NMOSD from MOGAD (p < 0.001).

Conclusions:

• Brighter spotty lesions (BSLs) on acute spinal MRI are a valuable imaging biomarker for differentiating AQP4-NMOSD from MOGAD.
• Incorporating BSL assessment into MRI analysis can improve diagnostic accuracy in patients with myelitis.
• This finding aids in guiding therapeutic strategies for these distinct neuroinflammatory diseases.