Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
Institute of Functional and Molecular Medical Imaging, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China.
Eur Radiol. 2020 Mar;30(3):1470-1479. doi: 10.1007/s00330-019-06506-z. Epub 2019 Nov 20.
Antibodies to myelin oligodendrocyte glycoprotein (MOG-ab) and antibodies to aquaporin-4 (AQP4-ab) have been suggested to play roles in commonly separated subsets of patients with neuromyelitis optica spectrum disorder (NMOSD) phenotypes. The aim of this study is to quantitatively delineate and compare the brain lesion distributions of AQP4-ab-positive and MOG-ab-positive patients.
Fifty-seven and twenty-eight clinical MRI scans were collected from fifty-two AQP4-ab-positive and twenty-four MOG-ab-positive patients, respectively. T2 lesions were segmented manually on each axial FLAIR image. Probabilistic lesion distribution maps were created for each group after spatial normalization. Lobe-wise and voxel-wise quantitative comparisons of the two distributions were performed. A classification model based on the lesion distribution features was constructed to differentiate the two patient groups.
Infratentorial and supratentorial brain lesions were found in both AQP4-ab-positive and MOG-ab-positive patients, with large inter-group overlap mainly in deep white matter (WM). In comparison with those in the AQP4 group, the brain lesions of the MOG-ab-positive patients had a larger size, dispersed distribution, and higher probabilities in the cerebellum, pons, midbrain, and GM and juxtacortical WM in temporal, sublobar, frontal, and parietal lobes. The area under the receiver operating characteristic curve of the lesion-distribution-based classification model was 0.951.
MOG-ab-positive and AQP4-ab-positive groups showed similar but quantitatively different brain lesion distributions. These results may help clinicians in considering MOG versus AQP4 in initial diagnosis, and add rationale for sending corresponding serologic testing.
• Brain lesion distributions of AQP-ab-positive and MOG-ab-positive NMOSD patients • Larger size, dispersed distribution, higher lesion probabilities in the cerebellum, pons, midbrain, and GM and juxtacortical WM in the MOG group • The lesion-distribution-based classification model differentiates the two groups with AUC = 0.951.
髓鞘少突胶质细胞糖蛋白（MOG-ab）抗体和水通道蛋白-4（AQP4-ab）抗体被认为在视神经脊髓炎谱系疾病（NMOSD）表型中常见的分离亚组患者中发挥作用。本研究旨在定量描绘和比较 AQP4-ab 阳性和 MOG-ab 阳性患者的脑损伤分布。
从 52 例 AQP4-ab 阳性和 24 例 MOG-ab 阳性患者中分别收集了 57 例和 28 例临床 MRI 扫描。在每个轴位 FLAIR 图像上手动分割 T2 病变。在空间归一化后，为每组创建概率性病变分布图。对两组分布进行脑叶和体素定量比较。基于病变分布特征构建分类模型，以区分两组患者。
AQP4-ab 阳性和 MOG-ab 阳性患者均存在幕下和幕上脑损伤，两组之间存在较大的深部白质（WM）重叠。与 AQP4 组相比，MOG-ab 阳性患者的脑损伤体积更大，分布更分散，小脑、脑桥、中脑和 GM 以及颞叶、亚叶、额叶和顶叶的皮质下 WM 的病变概率更高。基于病变分布的分类模型的受试者工作特征曲线下面积为 0.951。
MOG-ab 阳性和 AQP4-ab 阳性组表现出相似但定量不同的脑损伤分布。这些结果可能有助于临床医生在初始诊断时考虑 MOG 与 AQP4，并为发送相应的血清学检测提供依据。
AQP-ab 阳性和 MOG-ab 阳性 NMOSD 患者的脑损伤分布
MOG 组小脑、脑桥、中脑和 GM 以及皮质下 WM 的病变体积更大、分布更分散、病变概率更高
基于病变分布的分类模型可通过 AUC = 0.951 区分两组
