Comparison of MRI T2-lesion evolution in pediatric MOGAD, NMOSD, and MS

Area of Science:

• Neuroimmunology
• Pediatric Neurology
• Radiology

Background:

• Magnetic resonance imaging (MRI) T2-lesions resolve more frequently in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) compared to aquaporin-4 IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and multiple sclerosis (MS) in adults.
• Limited research exists on T2-lesion evolution in pediatric cases of these neuroinflammatory conditions.

Purpose of the Study:

• To investigate and compare the evolution of MRI T2-lesions in children diagnosed with MOGAD, AQP4+NMOSD, and MS.
• To determine if lesion resolution patterns differ significantly across these pediatric autoimmune neurological diseases.

Main Methods:

• A cohort of pediatric patients (<18 years) with a first clinical attack and abnormal MRI (within 6 weeks) were included.
• Follow-up MRIs were obtained >6 months post-attack, ensuring no relapses in the evaluated regions.
• The resolution or persistence of an index T2-lesion (symptomatic/largest) was assessed, along with the resolution of all T2-lesions and changes in lesion area.

Main Results:

• Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) demonstrated significantly higher rates of index T2-lesion resolution (brain 60%, spine 67%) and complete T2-lesion resolution (brain 40%, spine 58%) compared to AQP4+NMOSD and MS (p < 0.01).
• Reductions in median index T2-lesion area were greater in MOGAD compared to MS, with no significant difference from AQP4+NMOSD.
• No index T2-lesion resolution was observed in pediatric MS, and very limited resolution occurred in AQP4+NMOSD.

Conclusions:

• In pediatric patients, MRI T2-lesions resolve more frequently in MOGAD than in AQP4+NMOSD and MS.
• These findings in children mirror adult observations, suggesting that the observed differences in lesion evolution are primarily driven by underlying disease pathogenesis rather than patient age.