比较儿童 MOGAD、NMOSD 和 MS 的 MRI T2 病灶演变。
Comparison of MRI T2-lesion evolution in pediatric MOGAD, NMOSD, and MS.
机构信息
Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA/Vita-Salute San Raffaele University, Milan, Italy/Neuroimaging Research Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
出版信息
Mult Scler. 2023 Jun;29(7):799-808. doi: 10.1177/13524585231166834. Epub 2023 May 23.
BACKGROUND
Magnetic resonance imaging (MRI) T2-lesions resolve more often in myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) than aquaporin-4 IgG-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD) and multiple sclerosis (MS) in adults but few studies analyzed children.
OBJECTIVE
The main objective of this study is to investigate MRI T2-lesion evolution in pediatric MOGAD, AQP4 + NMOSD, and MS.
METHODS
Inclusion criteria were as follows: (1) first clinical attack; (2) abnormal MRI (⩽6 weeks); (3) follow-up MRI beyond 6 months without relapses in that region; and (4) age < 18 years. An index T2-lesion (symptomatic/largest) was identified, and T2-lesion resolution or persistence on follow-up MRI was determined.
RESULTS
We included 56 patients (MOGAD, 21; AQP4 + NMOSD, 8; MS, 27) with 69 attacks. Index T2-lesion resolution was more frequent in MOGAD (brain 9 of 15 [60%]; spine 8 of 12 [67%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]) and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), < 0.01. Resolution of all T2-lesions occurred more often in MOGAD (brain 6 of 15 [40%]; spine 7 of 12 [58%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]), and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), < 0.01. Reductions in median index T2-lesion area were greater in MOGAD (brain, 305 mm; spine, 23 mm) than MS (brain, 42 mm [<0.001]; spine, 10 mm [<0.001]) without differing from AQP4 + NMOSD (brain, 133 mm [=0.42]; spine, 19.5 mm [=0.69]).
CONCLUSION
In children, MRI T2-lesions resolved more often in MOGAD than AQP4 + NMOSD and MS which is similar to adults suggesting these differences are related to pathogenesis rather than age.
背景
与水通道蛋白 4 免疫球蛋白阳性视神经脊髓炎谱系障碍（AQP4+NMOSD）和多发性硬化症（MS）相比，磁共振成像（MRI）T2 病变在髓鞘少突胶质细胞糖蛋白（MOG）抗体相关性疾病（MOGAD）中更常消退，而在成人中很少有研究分析儿童。
目的
本研究的主要目的是研究儿科 MOGAD、AQP4+NMOSD 和 MS 的 MRI T2 病变演变。
方法
纳入标准如下：（1）首发临床发作；（2）异常 MRI（⩽6 周）；（3）在该区域无复发的情况下，随访 MRI 时间超过 6 个月；（4）年龄<18 岁。确定了一个索引 T2 病变（症状性/最大），并确定随访 MRI 上 T2 病变的消退或持续存在。
结果
我们纳入了 56 名患者（MOGAD，21 名；AQP4+NMOSD，8 名；MS，27 名），共 69 次发作。MOGAD（脑 15 例中有 9 例[60%]；脊柱 12 例中有 8 例[67%]）的索引 T2 病变消退比 AQP4+NMOSD（脑 4 例中有 1 例[25%]；脊柱 7 例中有 0 例[0%]）和 MS（脑 18 例中有 0 例[0%]；脊柱 13 例中有 1 例[8%]）更频繁，<0.01。MOGAD（脑 15 例中有 6 例[40%]；脊柱 12 例中有 7 例[58%]）的所有 T2 病变消退的频率高于 AQP4+NMOSD（脑 4 例中有 1 例[25%]；脊柱 7 例中有 0 例[0%]）和 MS（脑 18 例中有 0 例[0%]；脊柱 13 例中有 1 例[8%]），<0.01。MOGAD（脑，305 毫米；脊柱，23 毫米）的中位指数 T2 病变面积减少大于 MS（脑，42 毫米[<0.001]；脊柱，10 毫米[<0.001]），但与 AQP4+NMOSD（脑，133 毫米[=0.42]；脊柱，19.5 毫米[=0.69]）无差异。
结论
在儿童中，MOGAD 比 AQP4+NMOSD 和 MS 更常出现 MRI T2 病变消退，这与成人相似，提示这些差异与发病机制有关，而与年龄无关。
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