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Published on: August 21, 2017
Characteristics of MRI lesions in AQP4 antibody-positive NMOSD, MOGAD, and multiple sclerosis: a systematic review
Unnah Leitner1, Sin Hong Chew2, Jessica Blanch2
1School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, QLD, Australia. unnah.leitner@griffithuni.edu.au.
Background And Objectives:
Multiple sclerosis (MS), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab + ve NMOSD), and myelin oligodendrocyte glycoprotein-associated disease (MOGAD) are demyelinating diseases with differing pathophysiological processes and treatments. The objective of this study was to compile a comprehensive list of MRI lesions, and to quantify the utility of these lesions in distinguishing between these conditions.
Methods:
We searched for articles comparing MRI lesion frequency in MS, AQP4-Ab + ve NMOSD, MOGAD and healthy controls. Bayesian network meta-analysis together with pairwise and pooled case-case comparison analyses to develop sensitivity, specificity, and positive predictive values were undertaken.
Results:
Sixty-six articles were reported on 2933 MS, 3296 AQP4-Ab + ve NMOSD, and 1559 MOGAD cases, and 561 healthy controls. MRI lesions associated with MS were: periventricular T2, subcortical white matter T2, Dawson's finger, U-fibre T2 lesion, posterior spinal column T2, inferior temporal T2, cortical T2, brain T1 hypointensity (black holes), peripheral spinal cord T2, pons T2, unilateral optic nerve T2 and brain gadolinium enhancing lesions. Optic chiasm T2, LETM, bright spotty spinal cord T2, area postrema T2, hypothalamic T2, spinal cord atrophy and optic tract T2 lesions were associated with AQP4-Ab + ve NMOSD. Conus medullaris T2, fluffy, perineural enhancement, peri-ependymal 3rd ventricle T2 and peri-ependymal 4th ventricle T2 lesions were associated with MOGAD.
Discussion:
This review identified MRI features supportive of a diagnosis of MS, NMOSD or MOGAD, and has clarified the diagnostic utility of various MRI lesion characteristics, to aid in future clinical decision-making and guide future approaches to research.
Insights
Demyelinating diseases like multiple sclerosis (MS), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab+ve NMOSD), and MOG-associated disease (MOGAD) have distinct MRI lesion patterns. This study details these MRI features to aid in accurate diagnosis and treatment decisions.
Area of Science:
- Neuroimmunology
- Radiology
- Neurology
Background:
- Multiple sclerosis (MS), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab+ve NMOSD), and myelin oligodendrocyte glycoprotein-associated disease (MOGAD) are distinct demyelinating conditions.
- These diseases exhibit different underlying pathophysiology and require tailored treatment strategies.
- Accurate differentiation is crucial for effective patient management.
Purpose of the Study:
- To compile a comprehensive list of magnetic resonance imaging (MRI) lesions associated with MS, AQP4-Ab+ve NMOSD, and MOGAD.
- To quantify the diagnostic utility of specific MRI lesion characteristics in differentiating these conditions.
- To provide a resource for improved clinical decision-making.
Main Methods:
- Systematic literature search for studies comparing MRI lesion frequency across MS, AQP4-Ab+ve NMOSD, MOGAD, and healthy controls.
- Bayesian network meta-analysis and pairwise/pooled case-case comparisons were employed.
- Sensitivity, specificity, and positive predictive values for various MRI findings were calculated.
Main Results:
- Analysis of 66 articles involving 2933 MS, 3296 AQP4-Ab+ve NMOSD, 1559 MOGAD cases, and 561 controls.
- Distinct MRI lesion patterns were identified for each condition, including specific T2, T1, and contrast-enhancing lesions in the brain and spinal cord.
- Examples include periventricular lesions in MS, optic chiasm and brainstem lesions in AQP4-Ab+ve NMOSD, and spinal cord lesions in MOGAD.
Conclusions:
- This review successfully identified characteristic MRI features that support the diagnosis of MS, AQP4-Ab+ve NMOSD, or MOGAD.
- The diagnostic utility of various MRI lesion characteristics has been clarified.
- Findings will aid in future clinical decision-making and guide research directions in demyelinating diseases.
