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Updated: Oct 2, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Centrally-located transverse myelitis would facilitate the differentiation of NMOSD and MOG-AD from MS
Masoud Etemadifar1, Mehri Salari2, Mohammad Reza Etemadifar1
1Department of Functional Neurosurgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
Objectives:
Differentiating neuromyelitis optica spectrum disorder (NMOSD) and Myelin oligodendrocyte glycoprotein antibody disease (MOG-AD) from multiple sclerosis (MS) is important since MS therapies might result in progression and relapse of the former diseases. Evidence of long extending transverse myelitis (LETM) in magnetic resonance imaging (MRI) is one of the requirements to make an NMOSD diagnosis. However, centrally located lesions on spinal MRI may bring higher sensitivity and specificity to the NMOSD and MOG-AD diagnosis.
Methods:
We aimed to assess the association between NMOSD diagnosis and the presence of centrally located lesions at disease onset. We reviewed 102 medical records from the Isfahan MS clinic who presented with cervical cord lesions and 17 MS, 23 NMOSD, and 6 MOG-AD patients were selected. We collected demographic, clinical, and MRI data of patients who had clinical presentations of cervical cord lesion at disease onset, and the characteristics of the lesion were studied.
Results:
There was an association between NMOSD diagnosis and presence of a centrally located lesion (CLTM) (P < 0.001), presence of an LETM (P < 0.001), and an intermediate to high axial cord expansion (P < 0.001). CLTM and LETM can also be found in MOG-AD patients. The presence of CLTM (sensitivity and specificity: 95.65% and 69.56%), possessed higher sensitivity and specificity for NMO diagnosis than LETM presence (sensitivity and specificity: 78.26% and 43.47%).
Conclusion:
A diagnostic criteria including the centrality, location, and expansion of the transverse myelitis lesions, in addition to LETM, may be more accurate in the diagnosis of NMOSD and MOG-AD and their distinction from MS.
Insights
Centrally located lesions on spinal MRI are more sensitive and specific for diagnosing neuromyelitis optica spectrum disorder (NMOSD) and MOG-AD than long extending transverse myelitis (LETM). This finding aids in distinguishing these conditions from multiple sclerosis (MS).
Area of Science:
- Neuroimmunology
- Neuroradiology
- Clinical Neurology
Background:
- Differentiating neuromyelitis optica spectrum disorder (NMOSD) and Myelin oligodendrocyte glycoprotein antibody disease (MOG-AD) from multiple sclerosis (MS) is crucial, as MS therapies can worsen NMOSD and MOG-AD.
- Current NMOSD diagnostic criteria include evidence of long extending transverse myelitis (LETM) on MRI.
- Centrally located lesions on spinal MRI may offer improved diagnostic accuracy for NMOSD and MOG-AD.
Purpose of the Study:
- To investigate the association between centrally located lesions at disease onset and NMOSD diagnosis.
- To compare the diagnostic utility of centrally located lesions versus LETM in differentiating NMOSD and MOG-AD from MS.
Main Methods:
- Retrospective review of 102 medical records from patients presenting with cervical cord lesions at the Isfahan MS clinic.
- Selection of 17 MS, 23 NMOSD, and 6 MOG-AD patients for detailed analysis.
- Collection and analysis of demographic, clinical, and MRI data, focusing on the characteristics of cervical cord lesions at disease onset.
Main Results:
- A significant association was found between NMOSD diagnosis and the presence of centrally located lesions (CLTM), LETM, and intermediate to high axial cord expansion (all P < 0.001).
- CLTM and LETM were also observed in MOG-AD patients.
- CLTM demonstrated higher sensitivity (95.65%) and specificity (69.56%) for NMOSD diagnosis compared to LETM (sensitivity: 78.26%, specificity: 43.47%).
Conclusions:
- The presence and characteristics of transverse myelitis lesions, including centrality, location, and expansion, alongside LETM, are vital for accurate NMOSD and MOG-AD diagnosis.
- Incorporating lesion centrality into diagnostic criteria may enhance the differentiation of NMOSD and MOG-AD from MS.
