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Updated: Jul 29, 2025
Myelin Oligodendrocyte Glycoprotein MOG35-55 Induced Experimental Autoimmune Encephalomyelitis EAE in C57BL/6 Mice
Published on: April 15, 2014
Cerebral enhancement in MOG antibody-associated disease
Paul Elsbernd1,2, Laura Cacciaguerra3,4,5, Karl N Krecke6
1Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Introduction:
Limited data exist on brain MRI enhancement in myelin-oligodendrocyte-glycoprotein (MOG) antibody-associated disease (MOGAD) and differences from aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD), and multiple sclerosis (MS).
Methods:
In this retrospective observational study, we identified 122 Mayo Clinic MOGAD patients (1 January 1996-1 July 2020) with cerebral attacks. We explored enhancement patterns using a discovery set (n=41). We assessed enhancement frequency and Expanded Disability Status Scale scores at nadir and follow-up in the remainder (n=81). Two raters assessed T1-weighted-postgadolinium MRIs (1.5T/3T) for enhancement patterns in MOGAD, AQP4+NMOSD (n=14) and MS (n=26). Inter-rater agreement was assessed. Leptomeningeal enhancement clinical correlates were analysed.
Results:
Enhancement occurred in 59/81 (73%) MOGAD cerebral attacks but did not influence outcome. Enhancement was often patchy/heterogeneous in MOGAD (33/59 (56%)), AQP4+NMOSD (9/14 (64%); p=0.57) and MS (16/26 (62%); p=0.63). Leptomeningeal enhancement favoured MOGAD (27/59 (46%)) over AQP4+NMOSD (1/14 (7%); p=0.01) and MS (1/26 (4%); p<0.001) with headache, fever and seizures frequent clinical correlates. Ring enhancement favoured MS (8/26 (31%); p=0.006) over MOGAD (4/59 (7%)). Linear ependymal enhancement was unique to AQP4+NMOSD (2/14 (14%)) and persistent enhancement (>3 months) was rare (0%-8%) across all groups. Inter-rater agreement for enhancement patterns was moderate.
Conclusions:
Enhancement is common with MOGAD cerebral attacks and often has a non-specific patchy appearance and rarely persists beyond 3 months. Leptomeningeal enhancement favours MOGAD over AQP4+NMOSD and MS.
Insights
Brain MRI enhancement is common in myelin-oligodendrocyte-glycoprotein (MOG) antibody-associated disease (MOGAD) cerebral attacks, often appearing patchy. Leptomeningeal enhancement is more frequent in MOGAD compared to AQP4+NMOSD and MS.
Area of Science:
- Neuroimmunology
- Neuroradiology
- Neuroscience
Background:
- Limited data exist on brain MRI enhancement patterns in myelin-oligodendrocyte-glycoprotein (MOG) antibody-associated disease (MOGAD).
- Understanding these patterns is crucial for differentiating MOGAD from aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD) and multiple sclerosis (MS).
Purpose of the Study:
- To investigate and compare brain MRI enhancement patterns in MOGAD cerebral attacks with those in AQP4+NMOSD and MS.
- To identify specific enhancement features that may aid in distinguishing these conditions.
Main Methods:
- Retrospective observational study of 122 MOGAD patients with cerebral attacks.
- Analysis of T1-weighted post-gadolinium MRI scans from MOGAD, AQP4+NMOSD, and MS cohorts.
- Assessment of enhancement frequency, patterns (patchy, leptomeningeal, ring, linear ependymal), and persistence by two independent raters.
Main Results:
- Enhancement occurred in 73% of MOGAD cerebral attacks, typically patchy and heterogeneous.
- Leptomeningeal enhancement was significantly more frequent in MOGAD (46%) compared to AQP4+NMOSD (7%) and MS (4%).
- Ring enhancement favored MS (31%) over MOGAD (7%), while linear ependymal enhancement was unique to AQP4+NMOSD (14%).
Conclusions:
- Brain MRI enhancement is a common finding in MOGAD cerebral attacks, often presenting as non-specific patchy enhancement.
- Leptomeningeal enhancement is a distinguishing feature favoring MOGAD over AQP4+NMOSD and MS.
- Enhancement in MOGAD rarely persists beyond three months and does not appear to influence long-term outcomes.
