Burton Jodie M, Kasirye-Mbugua Napo, Costello Fiona, Assis Zarina
Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Department of Imaging, University of Calgary, Calgary, Alberta, Canada.
Mult Scler Relat Disord. 2025 May;97:106394. doi: 10.1016/j.msard.2025.106394. Epub 2025 Mar 17.
Magnetic resonance imaging (MRI) features in the 2023 MOGAD International Panel diagnostic criteria help distinguish myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOGAD) from mimics, particularly when MOG antibody titers are low. We evaluated the diagnostic performance of these MRI features in a large, previously diagnosed cohort.
All MOG IgG cell-based assays performed by Mitogen Dx laboratory in Alberta from July 2017 to July 2023 were retrieved. All MOG positive with a MOGAD presentation and => one MRI study of brain, spine, or optic nerves were identified. MRIs were re-evaluated by two neuroradiologists and a neurologist for MOGAD-like features. Sensitivity, specificity, likelihood ratios, and positive and negative predictive value were calculated based on diagnosis in all patients and low antibody titer patients specifically.
Of 3831 tested patients, 158 had MOG antibodies, a MOGAD-consistent presentation, and MRI(s) of brain, spine or optic nerves. Of these 158 patients, 102 were diagnosed with MOGAD. Compared to patients with higher antibody titers, low titer patients with MOGAD MRI features had preserved specificity and improved negative predictive value for a MOGAD diagnosis. Only MOGAD patients had lesion resolution.
When applying MRI features from the 2023 MOGAD diagnostic criteria to an existing cohort, there was good sensitivity and specificity for MOGAD with improved specificity and negative predictive value in those with low antibody titers. The odds of a MOGAD diagnosis were high when lesions resolved on repeated imaging, particularly versus multiple sclerosis, suggesting this feature may merit more weight in future diagnostic criteria.
2023年MOGAD国际专家组诊断标准中的磁共振成像（MRI）特征有助于将髓鞘少突胶质细胞糖蛋白（MOG）抗体病（MOGAD）与类似疾病区分开来，尤其是当MOG抗体滴度较低时。我们在一个大型的、先前已确诊的队列中评估了这些MRI特征的诊断性能。
检索了2017年7月至2023年7月艾伯塔省Mitogen Dx实验室进行的所有基于MOG IgG细胞的检测。确定所有MOG呈阳性且有MOGAD临床表现以及对脑、脊柱或视神经进行过≥1次MRI检查的患者。两名神经放射科医生和一名神经科医生对MRI进行重新评估，以寻找MOGAD样特征。根据所有患者尤其是低抗体滴度患者的诊断结果计算敏感性、特异性、似然比以及阳性和阴性预测值。
在3831名接受检测的患者中，158人有MOG抗体、符合MOGAD的临床表现且对脑、脊柱或视神经进行过MRI检查。在这158名患者中，102人被诊断为MOGAD。与抗体滴度较高的患者相比，具有MOGAD MRI特征的低滴度患者在MOGAD诊断中具有保留的特异性和改善的阴性预测值。只有MOGAD患者的病变得到缓解。
将2023年MOGAD诊断标准中的MRI特征应用于现有队列时，对MOGAD具有良好的敏感性和特异性，在低抗体滴度患者中特异性和阴性预测值有所提高。当病变在重复成像时得到缓解，MOGAD诊断的可能性很高，尤其是与多发性硬化症相比，这表明该特征在未来的诊断标准中可能值得给予更多权重。
