Volumetric MRI Comparing Longitudinal Change in MOGAD to NMOSD, MS and Healthy Controls, and Disability Associations

Area of Science:

• Neuroimmunology
• Neuroimaging
• Neurology

Background:

• Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelinating condition with overlapping features with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).
• Volumetric magnetic resonance imaging (vMRI) is crucial for assessing brain atrophy in neuroinflammatory diseases.

Purpose of the Study:

• To compare vMRI findings in MOGAD with MS, NMOSD, and healthy controls (HC).
• To investigate the relationship between brain volume changes and clinical disability in MOGAD.

Main Methods:

• Standardized vMRI was performed on 32 MOGAD patients, 160 MS patients, 49 NMOSD patients, and 52 HC.
• Mixed linear models analyzed longitudinal volume changes, comparing MOGAD to other groups.
• Disability was assessed using patient-determined disease steps (PDDS), manual dexterity (MDT), walking speed (WST), processing speed (PST), and contrast sensitivity tests (CST).

Main Results:

• MOGAD exhibited a faster rate of global brain volume loss compared to HC.
• MOGAD showed preserved deep gray matter volumes (thalamus, caudate, putamen) relative to MS at baseline.
• Longitudinally, MOGAD had increased lateral ventricle fraction but less hippocampal and upper cervical cord area (UCCA) loss compared to NMOSD and MS.
• In MOGAD, UCCA loss correlated with PDDS and CST; whole brain fraction with PDDS and PST; and LVF with PDDS.

Conclusions:

• MOGAD demonstrates significant longitudinal brain volume loss compared to HC.
• Distinct regional atrophy patterns exist, with MOGAD showing relatively preserved deep gray matter compared to MS and greater UCCA preservation than MS and NMOSD.
• Despite less overall atrophy, brain volume loss in MOGAD is associated with clinical disability, highlighting the importance of vMRI in understanding disease progression and impact.