Comparison of MRI Lesion Evolution in Different Central Nervous System Demyelinating Disorders

Abstract

Background and Objective:There are few studies that compare lesion evolution across different CNS demyelinating diseases, yet knowledge of this may be important for diagnosis and understanding differences in disease pathogenesis. We sought to compare MRI T2-lesion evolution in myelin-oligodendrocyte-glycoprotein-IgG-associated disorder (MOGAD), aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG-NMOSD), and multiple sclerosis (MS).Methods:In this descriptive study, we retrospectively identified Mayo Clinic patients with MOGAD, AQP4-IgG-NMOSD, or MS and: 1) brain or myelitis attack; 2) available attack MRI within 6 weeks; and 3) follow-up MRI beyond 6 months without interval relapses in that region. Two neurologists identified the symptomatic or largest T2-lesion for each patient (index lesion). MRIs were then independently reviewed by two neuroradiologists blinded to diagnosis to determine resolution of T2-lesions by consensus. The index T2-lesion area was manually outlined acutely and at follow-up to assess variation in size.Results:We included 156 patients (MOGAD, 38; AQP4-IgG-NMOSD, 51; MS, 67) with 172 attacks (brain, 81; myelitis, 91). The age (median [range]) differed between MOGAD (25 [2-74]), AQP4-IgG-NMOSD (53 [10-78]) and MS (37 [16-61]) (p<0.01) and female sex predominated in the AQP4-IgG-NMOSD (41/51 [80%]) and MS (51/67 [76%]) groups but not among those with MOGAD (17/38 [45%]). Complete resolution of the index T2-lesion was more frequent in MOGAD (brain, 13/18[72%]; spine, 22/28[79%]) than AQP4-IgG-NMOSD (brain, 3/21[14%]; spine, 0/34[0%]) and MS (brain, 7/42[17%]; spine, 0/29[0%]), p<0.001. Resolution of all T2-Lesions occurred most often in MOGAD (brain, 7/18[39%]; spine, 22/28[79%]) than AQP4-IgG-NMOSD (brain, 2/21[10%]; spine, 0/34[0%]), and MS (brain, 2/42[5%]; spine, 0/29[0%]), p< 0.01. There was a larger median (range) reduction in T2-lesion area in mm2 on follow-up axial brain MRI with MOGAD (213[55-873]) than AQP4-IgG-NMOSD (104[0.7-597]) (p=0.02) and MS, 36[0-506]) (p< 0.001) and the reductions in size on sagittal spine MRI follow-up in MOGAD (262[0-888]) and AQP4-IgG-NMOSD (309[0-1885]) were similar (p=0.4) and greater than MS (23[0-152]) (p<0.001).Conclusions:The MRI T2-lesions in MOGAD resolve completely more often than AQP4-IgG-NMOSD and MS. This has implications for diagnosis, monitoring disease activity, and clinical trial design, while also providing insight into pathogenesis of central nervous system demyelinating diseases.

Risk of disease relapse following COVID-19 vaccination in patients with AQP4-IgG-positive NMOSD and MOGAD

“…Our study is limited by the small sample size, the retrospective design, and exclusive exposure to mRNA-based vaccines (the incidence of relapses might be different following other types of vaccines) ( Fragoso et al, 2021 ). In addition, patients did not perform brain or spinal cord imaging during the post-vaccination follow-up, but clinically silent lesions are rare in these conditions and MOGAD lesions frequently resolve over time limiting the utility of MRI for disease activity monitoring ( Fadda et al, 2021 ; Sechi et al, 2021 ).…”

Frequency of New Silent MRI Lesions in Myelin Oligodendrocyte Glycoprotein Antibody Disease and Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disorder

“…However, these findings are relevant in actual clinical practice because these 2 diseases are currently managed. The shorter median interval for MOGAD remission MRIs and the greater tendency for lesions to resolve in MOGAD 14 could have led to an underestimation of new lesions compared with that in AQP4-NMOSD, but the opposite effect might also be true, because more AQP4-NMOSD patients were treated. Only a prospective study performing regular-interval MRI scans with patients not receiving treatments or receiving identical treatments would fairly compare the 2 treatment groups.…”

Clinical Significance of Myelin Oligodendrocyte Glycoprotein Autoantibodies in Patients with Typical MS Lesions on MRI

“… 1 , 2 , 8 Serial MRIs in MOGAD show resolution of T2-abnormalities in 50–70% of cases and rare occurrence of new asymptomatic lesions, in contrast to MS where T2-lesions typically persist and increase in number over years, suggesting a different pathophysiology. 9 , 10 In this study, all included patients showed clinical-MRI characteristics typical of MS both during attacks ( e.g. moderate attack severity with EDSS ≤ 5) and at follow-up ( e.g.…”